{
  "Profile_Information": {
    "public_name": "Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)",
    "state": "OHIO",
    "formulary_type": "Full",
    "formulary_name": "2023 MMP OH 23324",
    "formulary_id": 20686,
    "formulary_version": 9,
    "formulary_effective_date": "07/01/2023"
  },
  "Drug_Information": [
    {
      "ndc": "XXXMSXXXX53",
      "ndc_label_name": "20ML Potassium Chloride SOLUTION 2 MEQ/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53191021801",
      "ndc_label_name": "A-25 Capsule 7.5 MG (25000 UT) Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121089715",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089720",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722056224",
      "ndc_label_name": "Abacavir Sulfate SOLUTION 20 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040524",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378410591",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904652304",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904652306",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687404",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687406",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722055760",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004911",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004912",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020401",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020406",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505358306",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071703",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007360",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084002111",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084002121",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097051403",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518127400",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865016701",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865016760",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093538256",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573040230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573043030",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385096230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862033530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090030",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993048230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180028806",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097036202",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61269016660",
      "ndc_label_name": "ABDEK Pediatric Solution Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57665010141",
      "ndc_label_name": "Abelcet SUSPENSION 5 MG/ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148004580",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 300 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148007280",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 400 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001870",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001871",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001970",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001971",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093112589",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959721",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378692078",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904694804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714096301",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002412",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005703",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598035804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407018112",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894015512",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505432701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045511",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045521",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629942901",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679002101",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980041812",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048907",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462013508",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921017820",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205003092",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011001",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606056601",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789021398",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249001012",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82293000110",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378692191",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007360",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505476406",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629943001",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088260",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238175406",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921017706",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011101",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606057301",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82293000210",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093535286",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378633380",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721304",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063632",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010418",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079024101",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079024106",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012125",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012195",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382056928",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462043518",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014225",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014901",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014905",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014910",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013290",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781034201",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090582900",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045590",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380076006",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012210",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012211",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085600",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085611",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085630",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085655",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085660",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085672",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085678",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085690",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013360",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013390",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014025",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014701",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014705",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014710",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013090",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781034001",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045390",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380075806",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012010",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012011",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085400",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085411",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085430",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085455",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085460",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085472",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085478",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085490",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013160",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013190",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014120",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014125",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014801",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014805",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014810",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013190",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095109",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781034101",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013330",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013360",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013390",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289017142",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045490",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380075906",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012110",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012111",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085500",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085511",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085530",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085555",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085560",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085572",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085578",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085590",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013260",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013290",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73059000160",
      "ndc_label_name": "ACCRUFeR Capsule 30 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023110",
      "ndc_label_name": "Accutane Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023130",
      "ndc_label_name": "Accutane Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025110",
      "ndc_label_name": "Accutane Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025130",
      "ndc_label_name": "Accutane Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023210",
      "ndc_label_name": "Accutane Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023230",
      "ndc_label_name": "Accutane Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025210",
      "ndc_label_name": "Accutane Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025230",
      "ndc_label_name": "Accutane Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023310",
      "ndc_label_name": "Accutane Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023330",
      "ndc_label_name": "Accutane Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025310",
      "ndc_label_name": "Accutane Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025330",
      "ndc_label_name": "Accutane Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023410",
      "ndc_label_name": "Accutane Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143023430",
      "ndc_label_name": "Accutane Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025410",
      "ndc_label_name": "Accutane Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72143025430",
      "ndc_label_name": "Accutane Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378120001",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001001",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010190",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005011",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005015",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066601",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746066901",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559025501",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162066910",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378140001",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063101",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010290",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066701",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746067001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559025601",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162067010",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701416",
      "ndc_label_name": "Acetaminophen Childrens Solution 160 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904676620",
      "ndc_label_name": "Acetaminophen Childrens Suspension 160 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000031001",
      "ndc_label_name": "Acetaminophen Childrens TABLET CHEWABLE 160 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904688365",
      "ndc_label_name": "Acetaminophen ER Tablet Extended Release 650 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536129229",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001001",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802073230",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802073030",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 650 MG Rectal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483034001",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121050400",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050404",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050405",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050416",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100800",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100812",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007901",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007902",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007905",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261047001",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032304",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021500",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007905",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007906",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007912",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007913",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007916",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033705",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033706",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033912",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033913",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014103",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014104",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217021301",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432024516",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026612",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026638",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026648",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026690",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267099704",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233721",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005801",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020815",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025904",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025912",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025915",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025920",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025924",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025930",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025950",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025960",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005412",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005452",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048403",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048423",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048462",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702012",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702081",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702085",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702610",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702681",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702685",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702691",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233821",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233832",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544003215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544003220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052680",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005999",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000107",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000114",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000118",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000121",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000125",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000128",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000142",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000148",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000164",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001045",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001070",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001075",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006024",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157207",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193307",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520000",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520004",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520007",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436322707",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000306",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000312",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000315",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000316",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000324",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000325",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000328",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000340",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000342",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000345",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000350",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000375",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000384",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348001510",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118056203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118056206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060411",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032871",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032890",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048418",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048430",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187010615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081515",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081520",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081530",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629149410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020216",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020218",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020224",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020225",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000191",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000285",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000293",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037211",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788028503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788028506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518021200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262800",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298900",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025605",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025607",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025608",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054504",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054507",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054508",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054509",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181809",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011145",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011146",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011153",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011154",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011170",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011175",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011180",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005512",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005552",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035005",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233921",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233928",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006001",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006005",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006099",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000221",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000248",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000256",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044624",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061511",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090590",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304056101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026703",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026704",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026705",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026708",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026710",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026712",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026715",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026720",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026728",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026730",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026740",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026750",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026760",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026790",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000353",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000370",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000380",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047453",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047460",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047470",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047480",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047490",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785903",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785906",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518276400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005652",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555051302",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729033101",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155012001",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078701",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033003001",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571024301",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313200",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090594500",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004211",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004212",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742023301",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057811",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057821",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034931",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382026101",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710159101",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135077201",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008901",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090057701",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090451101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402201",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991088401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817020010",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072006",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072012",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429003301",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629119401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083306",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756072011",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954003330",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205030830",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000812",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004506",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004512",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888004701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527105001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904666361",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135056701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135077301",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028801",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009001",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010310",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999089212",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090300300",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090559300",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005411",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005415",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402301",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991088501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817020110",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022124",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429003401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061911",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629119501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083406",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756072111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954003430",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000912",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888004801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264230400",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264230410",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338065604",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409614309",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409614322",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614309",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614322",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090035100",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302000",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090626300",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383088915",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817081615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700098615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432074115",
      "ndc_label_name": "Acetic Acid SOLUTION 2 % OTIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432074116",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788723101",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330703",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330711",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517750401",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517750425",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517751003",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069130",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069310",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069504",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330803",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330811",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517760401",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517760425",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517761003",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069030",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069041",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069044",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069210",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069404",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069441",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069444",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904772714",
      "ndc_label_name": "Acid Gone SUSPENSION 95-358 MG/15ML ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113014165",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013890",
      "ndc_label_name": "Acidophilus Probiotic Capsule Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768005721",
      "ndc_label_name": "Acidophilus/Bifidus Wafer Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536718001",
      "ndc_label_name": "Acidophilus/Citrus Pectin Tablet Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904421360",
      "ndc_label_name": "Acidophilus/Pectin CAPSULE ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093113556",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378702093",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008630",
      "ndc_label_name": "Acitretin CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089430",
      "ndc_label_name": "Acitretin Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093113856",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115166808",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175108",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008730",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008108",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093113656",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378702393",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008830",
      "ndc_label_name": "Acitretin CAPSULE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089630",
      "ndc_label_name": "Acitretin Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536105875",
      "ndc_label_name": "Acne Medication 10 LOTION 10 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105775",
      "ndc_label_name": "Acne Medication 5 LOTION 5 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49281054503",
      "ndc_label_name": "ActHIB SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281054758",
      "ndc_label_name": "ActHIB SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987011110",
      "ndc_label_name": "Actimmune SOLUTION 2000000 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987011111",
      "ndc_label_name": "Actimmune SOLUTION 2000000 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "28595043330",
      "ndc_label_name": "Active FE TABLET 75-1.25 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603005",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603030",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703030",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703083",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703085",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904578961",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010125",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022905",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261041930",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261041960",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261041990",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000925",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001701",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001750",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063070135",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063070150",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082605",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082650",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088801",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088882",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038510",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038515",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038525",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038540",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059500",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059501",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059507",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059607",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561007",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573900",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573907",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006011",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006015",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051725",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051730",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051735",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051750",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024525",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024530",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024535",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024550",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024560",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062025",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027305",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027310",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027325",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027330",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027335",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027350",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289027605",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864087635",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429001201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429001205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505004206",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760060660",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760065225",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011101",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011105",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919033130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135003950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018290",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304065201",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304065205",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167602",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167603",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167604",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167605",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629200901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040410",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040414",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040415",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040420",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040424",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040425",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040430",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040435",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040440",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040450",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040460",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040470",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000625",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000640",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000650",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010701",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010711",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076014601",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020990",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205024390",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057830",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057890",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028000",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028001",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028002",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028003",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028004",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028005",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028006",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028007",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028008",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028009",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047000",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047001",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047002",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047003",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047004",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047005",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047006",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047007",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047008",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047009",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002805",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012401",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288003901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288003902",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015410",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015411",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015520",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015521",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032503",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032509",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032510",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032514",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032520",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032524",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004801",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004810",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004901",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004910",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378871273",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472008216",
      "ndc_label_name": "Acyclovir SUSPENSION 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856008205",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155048551",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722068147",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383081016",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689034216",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954018810",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007917",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440103130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603101",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603105",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703185",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904579061",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003925",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003940",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010225",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010240",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049128",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049160",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049190",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001015",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001028",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001060",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090315",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090330",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090340",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090360",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063000101",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034015",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034025",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034040",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034060",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092804",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092815",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092825",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092830",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092840",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092860",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008600",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008621",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008625",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008690",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064203",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064204",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064206",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064209",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064402",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064403",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064404",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064405",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064406",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064409",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064500",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156706",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325400",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006111",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006115",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054401",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054410",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054412",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054415",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054421",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054425",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054430",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054440",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054450",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054460",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000815",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000821",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000830",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000860",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018815",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018821",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018825",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018828",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018830",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018850",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018860",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062710",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062730",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046201",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046212",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046215",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046221",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046225",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046235",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046240",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289046260",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053935",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053940",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066415",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066435",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066440",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118894308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864060201",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864060230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429030901",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429030905",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530601",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530608",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011201",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011205",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037014",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037030",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919065430",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025315",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025330",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025360",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304050401",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167704",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167706",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167707",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629763803",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629763804",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739068210",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050015",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050020",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050021",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050025",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050040",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874050060",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000721",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000725",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000730",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010801",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010811",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079101",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079105",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734201",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734203",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734204",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734206",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734207",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734208",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734209",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738203",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738204",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738206",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738207",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738208",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757602",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757603",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757604",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757605",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757606",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757607",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757608",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757609",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776007",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776008",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820305",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029020",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518133202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934013130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051245",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055715",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055730",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055760",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069430",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069490",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005630",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205037130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205039125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047215",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022500",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022504",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022506",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022507",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022508",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335022509",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032300",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032301",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032302",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032303",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032304",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032305",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032306",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032307",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032308",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032309",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105306",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012201",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012205",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603301",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703385",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010340",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022716",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022725",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022730",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022735",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022740",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022750",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022760",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261022790",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001125",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001130",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001135",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058910",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058950",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093318",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999023135",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999023140",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063700",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063702",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063703",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162400",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633500",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006211",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006215",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014601",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014605",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067830",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067840",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067850",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002710",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002715",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002720",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002725",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002730",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002735",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002750",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002760",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031325",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031330",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031335",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031340",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031350",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062910",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062920",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062930",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062935",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062940",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289062950",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066335",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078635",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083535",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864019125",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864019135",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429031001",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429031005",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530701",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530705",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011301",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011305",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919000335",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053030",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053035",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001950",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057406",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057425",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304050501",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167804",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167807",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167808",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629917401",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629917402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040501",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040510",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040520",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040525",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040530",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874040535",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267039930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267039935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010901",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010911",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079201",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079205",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737804",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737806",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737807",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737808",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757506",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757507",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757508",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792302",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792303",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792304",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843404",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843405",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843408",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029120",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029130",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934013235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055635",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934082835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005330",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005335",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038830",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031903",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031904",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031905",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031906",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031907",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031908",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335031909",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069508",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138101",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138102",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138103",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138104",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138105",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138106",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138107",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138108",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138109",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023230",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012301",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012305",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040010",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040020",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040089",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "XXXMSXXXX60",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000004301",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353007002",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007004",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007006",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007012",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66302046760",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000308",
      "ndc_label_name": "Adefovir Dipivoxil TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505394703",
      "ndc_label_name": "Adefovir Dipivoxil Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025001",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025003",
      "ndc_label_name": "Adempas Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025091",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025101",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025103",
      "ndc_label_name": "Adempas Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025191",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025201",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025203",
      "ndc_label_name": "Adempas Tablet 1.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025291",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025301",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025303",
      "ndc_label_name": "Adempas Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025391",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025401",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025403",
      "ndc_label_name": "Adempas Tablet 2.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025491",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42023015901",
      "ndc_label_name": "Adrenalin Solution 1 MG/ML Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023015925",
      "ndc_label_name": "Adrenalin Solution 1 MG/ML Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069500",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069504",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261087301",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090073000",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090431000",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569524100",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518051400",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069600",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069604",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261087401",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090073100",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090450200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569524200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518053800",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069700",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069704",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090073200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090450500",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569524300",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071620",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071622",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090450400",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090450700",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071720",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071722",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071761",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071520",
      "ndc_label_name": "Advair HFA Aerosol 45-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071522",
      "ndc_label_name": "Advair HFA Aerosol 45-21 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079810",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084928",
      "ndc_label_name": "Afirmelle Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084988",
      "ndc_label_name": "Afirmelle Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513084300",
      "ndc_label_name": "Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55513084301",
      "ndc_label_name": "Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55513084101",
      "ndc_label_name": "Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47865010094",
      "ndc_label_name": "Airborne TABLET EFFERVESCENT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00316012601",
      "ndc_label_name": "Ala-Cort CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00316012830",
      "ndc_label_name": "Ala-Cort Cream 2.5 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50991078360",
      "ndc_label_name": "Ala-Hist IR TABLET 2 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50991078490",
      "ndc_label_name": "Alahist CF TABLET 10-2-20 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50991077601",
      "ndc_label_name": "Alahist D Tablet 17.5-10 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50991082616",
      "ndc_label_name": "Alahist DM Liquid 7.5-2-15 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50991078890",
      "ndc_label_name": "Alahist PE Tablet 2-7.5 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00115170149",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591271202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090701",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090702",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722093502",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009302",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598045202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407025802",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54505005522",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122101",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629927801",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097023772",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102106",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205005108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78482011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054074287",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093317431",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254100752",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781729685",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802008801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090413700",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090413800",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090413801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090414301",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517900",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517901",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523100",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573500",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090867",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066291",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629846801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993001968",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096301",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735302",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747702",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788102",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799602",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014260",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518285400",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021185",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205073285",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572001401",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067942",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420053101",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026601",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "XXXMSXXXX75",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation (NDA020503)",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "XXXMSXXXX74",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation (NDA020983)",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827052",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827055",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827091",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827093",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950103",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950125",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950160",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591379730",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591379760",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591379783",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715529",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715564",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715586",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261078901",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070349",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070352",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070354",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999034425",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051600",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051601",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090340000",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154435905",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687039579",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687039583",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071419902",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770202",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839902",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518241300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518261300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020025",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020030",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020060",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699152",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699198",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705752",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487030101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487030102",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346753",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001055",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699252",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699298",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705852",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705898",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990401",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990402",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990425",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346853",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001101",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001155",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990102",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 2.5 MG/0.5ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990130",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 2.5 MG/0.5ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472082516",
      "ndc_label_name": "Albuterol Sulfate SYRUP 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261066101",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383074016",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015303",
      "ndc_label_name": "Albuterol Sulfate SYRUP 2 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015306",
      "ndc_label_name": "Albuterol Sulfate SYRUP 2 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015309",
      "ndc_label_name": "Albuterol Sulfate SYRUP 2 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018941",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018947",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874070912",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874070924",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874070948",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010016",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788739004",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752010212",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378025501",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378025505",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704524",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704530",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090102",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065701",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065720",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407036701",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217001730",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017601",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017605",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036320",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036324",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036330",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629263801",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629263802",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037701",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037712",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037715",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037720",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037724",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874037730",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044201",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001030",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094925",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094995",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134401",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029010",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029018",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106101",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089800",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089811",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089830",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089855",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089860",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089890",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027301",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057205",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704630",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407036801",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959090620",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017701",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017705",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289004530",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629273601",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048501",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048503",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048512",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048515",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048520",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048524",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048530",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874048560",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044301",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095225",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095295",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134501",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029110",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029118",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089900",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089911",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089930",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089955",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089960",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089990",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027401",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026315",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026345",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026360",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130601",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130603",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130606",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030017",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030047",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030065",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026415",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026445",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026460",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131601",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131603",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131606",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029917",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029947",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029965",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468007001",
      "ndc_label_name": "Aldurazyme SOLUTION 2.9 MG/5ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013001",
      "ndc_label_name": "Alecensa Capsule 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054028259",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224030110",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954026410",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115167801",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115167808",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063101",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063102",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058801",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058830",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034001",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034003",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032730",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071079030",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115167926",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069612",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069644",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071812",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071844",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063201",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063202",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261099301",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090109100",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090407600",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217032101",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059048",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005572",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034114",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032804",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071157704",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022316",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022376",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013004",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013012",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282068145",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168126",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069712",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069720",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069744",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071912",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071944",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063301",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063302",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261055401",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356059404",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090232200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090232201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312600",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090469200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090469201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090567700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090567701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059248",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005672",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919068904",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034214",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032904",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713004",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823504",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022416",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022476",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013104",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013112",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013120",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518003301",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004804",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282068245",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29978091860",
      "ndc_label_name": "Alevazol OINTMENT 1 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378500577",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500001",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500005",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500030",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500060",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500081",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500090",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002101",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002105",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015519",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261099430",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074630",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074660",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094516",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094530",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094560",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095618",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095681",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095688",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237011490",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505285001",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034930",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235301",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235401",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024901",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084407",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084412",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030201",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030205",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030212",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030290",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884042411",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993014130",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884042511",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993014230",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000021101",
      "ndc_label_name": "Allergy Multi-Symptom TABLET 2-5-325 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69230030324",
      "ndc_label_name": "Allergy Relief (Cetirizine) Capsule 10 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000036201",
      "ndc_label_name": "Allergy Relief Tablet 5 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378013701",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378013710",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705030",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705081",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705085",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705091",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554310",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211521",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211532",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657161",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704161",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004107",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004110",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004112",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057601",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057602",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057603",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057604",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013401",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013416",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069301",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034905",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034910",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261081000",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261081030",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261081060",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261081090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001200",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007960",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079320",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079360",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079390",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063093501",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097520",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097590",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999037490",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254403",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254404",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090376003",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090376004",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466203",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466204",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516804",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006311",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006315",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020501",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020520",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959047300",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959047330",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015601",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015605",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015610",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700087990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700094790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211503",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018001",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018010",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018018",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067711",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013490",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051631",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051690",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098801",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098811",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167504",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739041010",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075401",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075412",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075414",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075420",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075430",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075440",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075460",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243011509",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030509",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030518",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066530",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066560",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066590",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073630",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073660",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073674",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073680",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098860",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098880",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738303",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738309",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045100",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045102",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045103",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045104",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518167801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007230",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934020930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046702",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046704",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046705",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335046706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019430",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019460",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019480",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019760",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019780",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162114900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189043790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018101",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018105",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705181",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705185",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705191",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554401",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554405",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211621",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211628",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211632",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904261460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657261",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004210",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004211",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057702",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013501",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013516",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069405",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035010",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261059730",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261059760",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261059790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261059799",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358001360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063077430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063077490",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063093401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097630",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097690",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353008860",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018660",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999024503",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090004400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090004403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186700",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186703",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006411",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006415",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742013601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742013605",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020601",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020620",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031100",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031130",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031160",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015701",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015705",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015710",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001003",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001030",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700003530",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700003590",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054030",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054090",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700093590",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018101",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018105",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068801",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068811",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013990",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047130",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051731",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071311",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187024090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739079610",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075501",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075510",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075512",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075514",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075520",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075530",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075540",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075550",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874075590",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243035509",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022430",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022490",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544031360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544037130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544037160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754209",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788983103",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000901",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000902",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157302",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180600",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518328900",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934050430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004930",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205037790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335011201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335011202",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335011203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335011204",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335059901",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335059902",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335059903",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335059904",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006445",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006460",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610023160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115000",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189041790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43553324913",
      "ndc_label_name": "Aloe Vesta Protective OINTMENT EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054029513",
      "ndc_label_name": "Alosetron HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291012330",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963047903",
      "ndc_label_name": "Alosetron HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884081911",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980045303",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162024803",
      "ndc_label_name": "Alosetron HCl TABLET 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756070230",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054029613",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291012430",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963048003",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884082011",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980045403",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162024903",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756070130",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "07610012012",
      "ndc_label_name": "Alpha-Lipoic Acid CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000139",
      "ndc_label_name": "Alpha-Lipoic Acid CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29135061515",
      "ndc_label_name": "Alpha-Lipoic Acid CAPSULE 300 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845013145",
      "ndc_label_name": "Alpha-Lipoic Acid Capsule 50 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768017965",
      "ndc_label_name": "Alpha-Lipoic Acid CAPSULE 600 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00023932105",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932110",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932115",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228202710",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202750",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202796",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400105",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707006",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707060",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707090",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106101",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106105",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106110",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544002930",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544005430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544015530",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544015560",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544015590",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059420",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059490",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037005",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037020",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037060",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037090",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037098",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035715",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035753",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035760",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035770",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070515",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070530",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070553",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070560",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070570",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003930",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003960",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225600",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225604",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078801",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078820",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070401",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070405",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032100",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032102",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032110",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032114",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032120",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032130",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032160",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032190",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042260",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042290",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371901",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371903",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371904",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091630",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739064410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025101",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025102",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025110",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025112",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025114",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025115",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025120",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025172",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025174",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025177",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025190",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067605",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067699",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021930",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021960",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021990",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090010",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090011",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090050",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000515",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000530",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000545",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000553",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000560",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000570",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000580",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788202703",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788202709",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635802",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635803",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635806",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635809",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071830",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335081301",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011253",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011260",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011270",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008706",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015106",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202910",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202950",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202996",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400305",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707106",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707110",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707130",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707160",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707190",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707191",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107701",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107705",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107710",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585961",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000402",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000407",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000410",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000414",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000420",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000421",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000428",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000440",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000490",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001540",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001590",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036706",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036715",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036730",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036760",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036790",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036798",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035820",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035830",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035845",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035853",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035860",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035870",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035875",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035880",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035892",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055555",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055590",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003215",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003260",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175900",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175901",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526100",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463501",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463502",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078901",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078920",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070505",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070510",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045700",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045702",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045715",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045720",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045728",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045730",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045742",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045745",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045760",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045790",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039505",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039510",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039515",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039520",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039530",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031330",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031360",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031390",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372001",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372003",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372004",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045630",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084960",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154104",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154105",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154106",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629154107",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772600",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772601",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772602",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772603",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772604",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772605",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772606",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772607",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772608",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772609",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739066910",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025201",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025204",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025206",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025209",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025210",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025212",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025214",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025215",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025218",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025220",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025224",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025250",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025260",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025272",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025274",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025277",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025290",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067701",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067705",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067799",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001330",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001360",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001390",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090110",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090111",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090150",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000615",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000620",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000630",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000645",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000653",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000660",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000670",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000675",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000680",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041915",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041920",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041945",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041953",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041960",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041970",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041975",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041980",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062915",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062920",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062945",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062953",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062955",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062960",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062970",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062975",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062980",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062990",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544062992",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071201509",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788202903",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788202906",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759502",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759503",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759506",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759508",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759509",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839803",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839806",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839809",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841003",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841006",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841009",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025200",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025201",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025203",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025204",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025205",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025206",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025207",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025208",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025209",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076105",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076106",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084905",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084906",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092900",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092901",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092903",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092904",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092905",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092906",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092907",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092908",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092909",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109205",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109206",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024030",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044290",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002406",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002490",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031360",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031390",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028401",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028402",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203110",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203150",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203196",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400505",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707291",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107901",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107905",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107910",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904586061",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010630",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000500",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000502",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000506",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000515",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000530",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000560",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000590",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001600",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001610",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001620",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001630",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001640",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001660",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074490",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036440",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036490",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036498",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060940",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060990",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035930",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035945",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035953",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035960",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035970",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035975",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035980",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035990",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057215",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057253",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057260",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057270",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057275",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057280",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242501",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242502",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242503",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525802",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525803",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463601",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463602",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463603",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079001",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079020",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070610",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052400",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052402",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052406",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052410",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052414",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052428",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052430",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052460",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052490",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092006",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092040",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092060",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049130",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049160",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049190",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118060509",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372101",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372103",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372104",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050415",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050418",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000630",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000660",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083630",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083660",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083690",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044330",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294200",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294201",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294202",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294203",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294204",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294205",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294206",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294207",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294208",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294209",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739067410",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025301",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025303",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025304",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025310",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025312",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025314",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025315",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025318",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025320",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025321",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025324",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025325",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025328",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025340",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025350",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025372",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025373",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025374",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025377",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025390",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067805",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067899",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001490",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001491",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090210",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090211",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090250",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000753",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000760",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000770",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000780",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000790",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029015",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029045",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029053",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029055",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029060",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029070",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029075",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029080",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029090",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034753",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034760",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034770",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034780",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034790",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042015",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042045",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042053",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042055",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042060",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042070",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042075",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042080",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544042090",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638101",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638102",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638103",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638106",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638108",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638109",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759606",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759608",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759609",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839403",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839408",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839409",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278500",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325900",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022710",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009800",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009802",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009803",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009804",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009805",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009806",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009807",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009808",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009809",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068000",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068001",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068003",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068004",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068005",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068006",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068007",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068008",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068009",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011353",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011370",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203910",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400701",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707360",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707390",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108901",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010730",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261050002",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261050030",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261050060",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261050090",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001740",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001760",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358001790",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082840",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526201",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070701",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070705",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086400",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086410",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086430",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086440",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086460",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086490",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052301",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052330",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052340",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052360",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052390",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060230",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060260",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062230",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062260",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372201",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372203",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050518",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057660",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057690",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086260",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330801",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330802",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330803",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330804",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101601",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101602",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101603",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101604",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101605",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101606",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101608",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874101609",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056491",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090310",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090350",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761302",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761303",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761306",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761309",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943002",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943003",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943006",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943009",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067301",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067302",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067303",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067304",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067305",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067306",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005860",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012160",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045060",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208035305",
      "ndc_label_name": "Alrex SUSPENSION 0.2 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208035310",
      "ndc_label_name": "Alrex SUSPENSION 0.2 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700011684",
      "ndc_label_name": "Altavera Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700011685",
      "ndc_label_name": "Altavera Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515062830",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515062930",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515063030",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904683973",
      "ndc_label_name": "Alum & Mag Hydroxide-Simeth Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689006099",
      "ndc_label_name": "Alumina-Magnesia-Simethicone Suspension 200-200-20 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536009185",
      "ndc_label_name": "Aluminum Hydroxide Gel SUSPENSION 320 MG/5ML ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63020018030",
      "ndc_label_name": "Alunbrig Tablet 180 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020011330",
      "ndc_label_name": "Alunbrig Tablet 30 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76189011318",
      "ndc_label_name": "Alunbrig Tablet 30 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76189011321",
      "ndc_label_name": "Alunbrig Tablet 30 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020009007",
      "ndc_label_name": "Alunbrig Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020009030",
      "ndc_label_name": "Alunbrig Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020019830",
      "ndc_label_name": "Alunbrig Tablet Therapy Pack 90 & 180 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090147700",
      "ndc_label_name": "Alyacen 1/35 Tablet 1-35 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462039429",
      "ndc_label_name": "Alyacen 1/35 TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462039484",
      "ndc_label_name": "Alyacen 1/35 TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090147800",
      "ndc_label_name": "Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462055629",
      "ndc_label_name": "Alyacen 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462055684",
      "ndc_label_name": "Alyacen 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093333406",
      "ndc_label_name": "Alyq Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180082911",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180082913",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180082971",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180082973",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083011",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083013",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083071",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083073",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440707504",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707506",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707510",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707520",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527170401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527170405",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591493001",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591493005",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781204801",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781204805",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832101500",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832101550",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663006",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663061",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704206",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704240",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704259",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704261",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083450",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155036201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155036205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077300",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077310",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077314",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077330",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077360",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261077390",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291012550",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543049301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543049305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085318",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094705",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006911",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006915",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079024720",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000710",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000714",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000715",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000720",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000730",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000760",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001210",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001214",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001220",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58864079510",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042201",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042211",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332024631",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332024671",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268101",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268102",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268103",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268104",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001514",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001520",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382051201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382051205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697501",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697502",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697503",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697504",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014220",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014230",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022320",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070220",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041230",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003330",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152007601",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152007605",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121064610",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121064616",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080710",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080712",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080716",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569563500",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432009316",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687023942",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687023956",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001047",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492001",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492005",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011100",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011103",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011150",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011189",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069201",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069205",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049701",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049705",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746069901",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332058631",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097092507",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097092512",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338100",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338101",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007501",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007505",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378427193",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240630",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005208",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023783",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035411",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035462",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049530",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505455303",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038702",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710118003",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427093",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240530",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005108",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023683",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035311",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035362",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049430",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505455203",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038602",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710117903",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862004701",
      "ndc_label_name": "Amethia TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862004791",
      "ndc_label_name": "Amethia TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616601",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616610",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703904001",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703904003",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029032",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029042",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078631",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078641",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017304",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081504",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081522",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616701",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616710",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703903201",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703903203",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029031",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029041",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078531",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078541",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017302",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081502",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081521",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574029201",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291012290",
      "ndc_label_name": "AMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794000502",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011701",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011710",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007111",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007115",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429027501",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429027590",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211401",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980015101",
      "ndc_label_name": "AMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057701",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057705",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048302",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048305",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051301",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987501",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987510",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987525",
      "ndc_label_name": "Amiodarone HCl SOLUTION 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021030266",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150018003",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323061603",
      "ndc_label_name": "Amiodarone HCl SOLUTION 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457015300",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457015303",
      "ndc_label_name": "Amiodarone HCl SOLUTION 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518123100",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518123101",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518279200",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518279201",
      "ndc_label_name": "Amiodarone HCl Solution 150 MG/3ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150018109",
      "ndc_label_name": "Amiodarone HCl Solution 450 MG/9ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323061609",
      "ndc_label_name": "Amiodarone HCl SOLUTION 450 MG/9ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457015309",
      "ndc_label_name": "Amiodarone HCl SOLUTION 450 MG/9ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457015399",
      "ndc_label_name": "Amiodarone HCl Solution 450 MG/9ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150018218",
      "ndc_label_name": "Amiodarone HCl Solution 900 MG/18ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457015318",
      "ndc_label_name": "Amiodarone HCl Solution 900 MG/18ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084301",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011890",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030703",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009711",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009715",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405506",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024030",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629207601",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929401",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382029706",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006030",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014405",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014409",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014460",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781120392",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904655661",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904699361",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084401",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084402",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035916",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356000110",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356000190",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090301501",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090301502",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576601",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576602",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402504",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024105",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024160",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043701",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043711",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005110",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739038710",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073205",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073260",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037101",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037111",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022705",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022714",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518193900",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518193901",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518324600",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335088102",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335088104",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003960",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084501",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013930",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030903",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405700",
      "ndc_label_name": "Amiodarone HCl TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405706",
      "ndc_label_name": "Amiodarone HCl TABLET 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024230",
      "ndc_label_name": "Amiodarone HCl TABLET 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629200101",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382029806",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006130",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378261001",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378261010",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709081",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709085",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221221",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221232",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148610",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544025030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025702",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044602",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017101",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017117",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041910",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045902",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045910",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045912",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045920",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045930",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045960",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045990",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002215",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002230",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002260",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030630",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030653",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030660",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030680",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999020500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999020560",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003000",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003001",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003006",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617900",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617906",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013101",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013120",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000802",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000815",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000820",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000830",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000840",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000850",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000860",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000890",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049100",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027360",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289012412",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289012430",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700024130",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700024190",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068718",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068788",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864002430",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760021215",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760021230",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760021290",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760055615",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001190",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919011730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919011760",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187063730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031101",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031102",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031104",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031110",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031112",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031115",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031120",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031124",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031130",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031140",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031150",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031160",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031172",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031174",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031177",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031190",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001830",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001860",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001890",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632003",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632006",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632008",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632009",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821806",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821809",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69158000000",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153800",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153801",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153802",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153804",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153805",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020111",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020112",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033130",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039502",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039503",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039504",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039505",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039506",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039507",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039508",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039509",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189043190",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017201",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017202",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378268501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709481",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709485",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709490",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221621",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017501",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042301",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062630",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062660",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062690",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074130",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074330",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063019360",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090033302",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090356402",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398502",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641802",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079056301",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079056320",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054214",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054215",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054221",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054228",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054230",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054240",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054242",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700039130",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066030",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069088",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864075730",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022330",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022360",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022390",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267056090",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689903",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689906",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689908",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689909",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838003",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838006",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838008",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838009",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518150500",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518150501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020511",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335004001",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335004005",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023930",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023960",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023990",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028702",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028703",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378269501",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221721",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017601",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042401",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094430",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094460",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094490",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069188",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037430",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037445",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518225800",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518225801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710123001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020611",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378262501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378262510",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709160",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709181",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709185",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709190",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709191",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709192",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709194",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221321",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221332",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148710",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020161",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718461",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010930",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634040171",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025802",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044702",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017201",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017217",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042010",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002320",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356071200",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082230",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086328",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016353",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006350",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006390",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003108",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284000",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284004",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284008",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400504",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631304",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631308",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307201",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307202",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307205",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010701",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010720",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034800",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034802",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034810",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034812",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034814",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034815",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034820",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034830",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034850",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034860",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034890",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033900",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217026930",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217026960",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217026990",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154566500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073012",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073025",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060000",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068818",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068888",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211306",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211403",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211406",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864002215",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864002230",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043311",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036700",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036730",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036760",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028990",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040814",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040815",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040860",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040890",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136902",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136903",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136904",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136905",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136906",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136907",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136908",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136909",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136910",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043002",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043004",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043014",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043015",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043020",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043025",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043028",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043040",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043050",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874043090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243000603",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243000609",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243024203",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243024209",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001914",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001930",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001990",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001991",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100600",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008553",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008560",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008570",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008575",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544008580",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682503",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682506",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682508",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682509",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834603",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834606",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834608",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834609",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69158000100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518148400",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518148401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122600",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020211",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020212",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030600",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030602",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030603",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030604",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030605",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030606",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030607",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030608",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030609",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125402",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125404",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125406",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023730",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023760",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023790",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021202",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021203",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028502",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000430",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000490",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378265001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378265010",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709281",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709285",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709290",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709291",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709292",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709294",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221421",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221432",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148810",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020261",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718561",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544011030",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044802",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017301",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017317",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042110",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035800",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035802",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035803",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035807",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035814",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035820",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035821",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035828",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035830",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035860",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261035890",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074290",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063083630",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016453",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999022800",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999022830",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999022860",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026402",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026405",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255305",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090297200",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631500",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631502",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631505",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307301",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307302",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436371001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013320",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051400",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051401",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051410",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051420",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051421",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051430",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051460",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051490",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001630",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001660",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061960",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068918",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068988",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864002330",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044411",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001330",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001360",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001371",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001390",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007630",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007660",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007690",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919024060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015530",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187035930",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212201",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898702",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898703",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035904",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035914",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035915",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035920",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035928",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035940",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035950",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035960",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874035990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002030",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002090",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025330",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025353",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025360",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025370",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706103",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706106",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706108",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706109",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836303",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836306",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836308",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836309",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69158000200",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518049301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122700",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020311",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020312",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036601",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036602",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036603",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036604",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036605",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036606",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036607",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036608",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125602",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125603",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125604",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044090",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023830",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023860",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023890",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425013701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008002730",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378267501",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709381",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709385",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221521",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017401",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042201",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036360",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036390",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356075930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063033630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063033660",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090960",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014701",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014720",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028400",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028430",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028460",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700068930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069288",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760018130",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760022130",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919054190",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629359705",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029601",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029604",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029615",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029620",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029640",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029660",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874029690",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643201",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643203",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643206",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643208",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643209",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833901",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833903",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833906",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833908",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833909",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518257000",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020411",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335017301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044430",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714330",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714381",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714385",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714390",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227401",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227410",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082500",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082530",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082560",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082590",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141800",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141801",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642701",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034105",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014605",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058605",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816803",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256600",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335080303",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026090",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090146300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014705",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037030",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058705",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013100",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714030",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714081",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714085",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714090",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082330",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082360",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082390",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033801",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180075501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714130",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714181",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714185",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714190",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227210",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082430",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082460",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261082490",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063023360",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033905",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014305",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058305",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180075601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518192800",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242100",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330300",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714230",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714281",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714285",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227310",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261098200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261098230",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261098260",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261098290",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040260",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057190",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618500",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034005",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014405",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058405",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180075701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012230",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335700",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014505",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058505",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180075901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303000",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378521005",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378521077",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509800",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509805",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716898",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904637161",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076110",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024305",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024310",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024319",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039819",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053502",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053560",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342001610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005709",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063004130",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063004190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053430",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053445",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053460",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069160",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023209",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023211",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152901",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258100",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258101",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535400",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008511",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008515",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079045201",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079045220",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111027105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111027190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700001518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700001530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700001560",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054130",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074030",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005713",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005718",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005799",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057013",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057018",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057099",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762213501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762213509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049601",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049611",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013230",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760044530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760045930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760045990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760061430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919046030",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919046090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078230",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919080530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919080590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187091430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187091490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739063110",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010399",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099315",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099330",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099331",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099345",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099360",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019910",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071070730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071134900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072103",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072109",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075203",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012316",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645051654",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645058054",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638601",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638606",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680503",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680506",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680509",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798506",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002309",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002390",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002393",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263200",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263201",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263202",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263203",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033090",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014806",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205048890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050630",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021802",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021804",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079901",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079902",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046953",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062035",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062045",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062060",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062080",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026230",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026260",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026290",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026295",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023910",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378520805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378520877",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509600",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509605",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509660",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480008305",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480008398",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904636961",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052403",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052405",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052410",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135075910",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135075990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024105",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024110",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024119",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039619",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261082600",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261082630",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261082660",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261082690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031309",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031318",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023011",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008311",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008315",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111026990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073830",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005513",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005599",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056813",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056818",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056899",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762224203",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762224209",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919075390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078330",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010199",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180071909",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012116",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725901",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725903",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725906",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788762301",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788762303",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788762306",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788762309",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767901",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767903",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767906",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767909",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826301",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826303",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826306",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826309",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002109",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002150",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002190",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197100",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197101",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083302",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053560",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008230",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026095",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378520905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378520977",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509700",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509705",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509760",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716798",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904637061",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024205",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024210",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024219",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039719",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043700",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043702",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043760",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342001510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356005930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356005960",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074010",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031409",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031418",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025115",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025145",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054545",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068415",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068430",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068445",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068460",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023109",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547023111",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152700",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252400",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090287600",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008411",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008415",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079045101",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079045120",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655005225",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091130",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111027005",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111027090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054330",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054360",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005613",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005618",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005699",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056913",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056918",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056999",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048811",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919029530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919029571",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919081460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084471",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010299",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544097915",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544097930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544097945",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544097960",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071072830",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071134800",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075103",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075109",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012216",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645051554",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680309",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693501",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693503",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693506",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693509",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831309",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002209",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002290",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002295",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518027400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518027401",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037600",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037601",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037602",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518083502",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518191400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298100",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298101",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298102",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298103",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934028830",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014703",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014706",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059630",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059990",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047302",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047304",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047305",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047307",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083402",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053960",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026195",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378172293",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781562831",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668020630",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084503",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084509",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002230",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008203",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008209",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884057511",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020630",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020690",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073930",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076506",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172493",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781564331",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668020430",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084703",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084709",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002330",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008003",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008009",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884057711",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247100",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320900",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020890",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074030",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076706",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172193",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781561531",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668020730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084403",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084409",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002030",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008303",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008309",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884057411",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020530",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020590",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076406",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172393",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781563931",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668020530",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084603",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084609",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002130",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008103",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008109",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884057611",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020790",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076606",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451793",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032130",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032190",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505347903",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027030",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451893",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031830",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031890",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673101",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348403",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027130",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451993",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031530",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031590",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348903",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027230",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378452093",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031330",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673301",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505349303",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451093",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451193",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032030",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671101",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026430",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451293",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031730",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026530",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451393",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032230",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032290",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505347803",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026630",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451493",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031930",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031990",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672101",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348303",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026730",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451593",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031630",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031690",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348803",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026830",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451693",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031430",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672301",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505349203",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026930",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093702956",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702998",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031230",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008503",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008509",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019207",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019210",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023630",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023690",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077383",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077399",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458403",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021490",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085630",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050030",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050090",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056730",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056790",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093703056",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093703098",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031130",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031190",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008603",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008609",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019307",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019310",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023830",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023890",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077583",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077599",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458503",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021590",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085730",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050230",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056930",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056990",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702756",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702798",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032430",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032490",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008303",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008309",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019007",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019010",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023530",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023590",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077283",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077299",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458203",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021230",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049930",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049990",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056630",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056690",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702856",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702898",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031330",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031390",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008403",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008409",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019107",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019110",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023730",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023790",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077483",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077499",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458303",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021330",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021390",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050130",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050190",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056830",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056890",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904598348",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802049326",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802049383",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802051377",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672130100",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130104",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63044040420",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518244900",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71399049404",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904598426",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904598463",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802041926",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802041954",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802052526",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802052555",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672130005",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130009",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63044048409",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399014004",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399014008",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378661185",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661193",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661285",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661293",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661485",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661493",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571501",
      "ndc_label_name": "Amoxapine TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571630",
      "ndc_label_name": "Amoxapine TABLET 150 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571301",
      "ndc_label_name": "Amoxapine TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571401",
      "ndc_label_name": "Amoxapine TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310701",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310705",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993801",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993805",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440110030",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710004",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710006",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710009",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710030",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202076",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029801",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029802",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002510",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002520",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002530",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021310",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021318",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001504",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001506",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001515",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001521",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001524",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001530",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001540",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001560",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057404",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057406",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057415",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057421",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057430",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001604",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090028800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182600",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182601",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436721803",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001120",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001121",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001124",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001130",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001140",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001160",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020830",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348054530",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001906",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001915",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001921",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001924",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001930",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001940",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001960",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700056030",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864002830",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010101",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010103",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010105",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010109",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010115",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010118",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010120",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010121",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010124",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010128",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010130",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010140",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010145",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010150",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001605",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002115",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002121",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002130",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788636902",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788636903",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781203",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824002",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008730",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015494",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934040721",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022501",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022505",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007404",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007406",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007430",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007701",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007782",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310953",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440110130",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710109",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710130",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261301",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261305",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261376",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061921",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061930",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061942",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15749082510",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029902",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029903",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029904",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013710",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013712",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013714",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013715",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013728",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013740",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013760",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013784",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002800",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002810",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002816",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002820",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002821",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002830",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002840",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002845",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002860",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021410",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021418",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001706",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001709",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001714",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001715",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001724",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001728",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001740",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001742",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001750",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001756",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001760",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063001763",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056306",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056308",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056309",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056314",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056315",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056321",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056328",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056330",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056340",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056356",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056360",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056363",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082008",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082014",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082015",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082020",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082021",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082028",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082050",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082056",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001506",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001508",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001520",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001542",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001545",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030207",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179402",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179407",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179506",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179601",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181200",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655089452",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002000",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002004",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002005",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002006",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002018",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002020",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002021",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002024",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002028",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002030",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002040",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002042",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002060",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021615",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021621",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021640",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021642",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021656",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021710",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055006",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002004",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002006",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002009",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002014",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002015",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002021",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002024",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002028",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002030",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002040",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002042",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002050",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002056",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002060",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002063",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700000720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700000730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700007520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700007530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700007560",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040630",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700041630",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003101",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003105",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001620",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919035520",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919035530",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066610",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066621",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919099420",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919099430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004430",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039910",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039914",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039920",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039921",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039930",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039940",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039960",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421601",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421801",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426501",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010201",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010203",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010209",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010210",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010212",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010214",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010215",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010218",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010220",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010221",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010224",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010228",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010230",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010240",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010245",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874010250",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001705",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002304",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002308",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002309",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002315",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002320",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002321",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002330",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002340",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002360",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267076404",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788637403",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820902",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820903",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820904",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897202",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897203",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897204",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788903302",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788903303",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219003",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219007",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518323400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518323401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003320",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003321",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003330",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003392",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003393",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003394",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005421",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005430",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005440",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005492",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005493",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005494",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050714",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050740",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007510",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007801",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007882",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789022582",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420019221",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050850",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420054550",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425026901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988815",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988880",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603946",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603955",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603958",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261060201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019100",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019180",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040400",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090300500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018100",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018101",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018108",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018180",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021493",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217011901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020015",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070655",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070680",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026680",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416073",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416076",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416078",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988650",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988675",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615646",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615652",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615657",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261076601",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084301",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217024901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031601",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003250",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003275",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039932",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067232",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007001",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007050",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007075",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788732301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415573",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415579",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415580",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988915",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988980",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604146",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604155",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604158",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046001",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261072601",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016800",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016850",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016880",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090041100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090225100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090634900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020991",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020993",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217031401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001533",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071633",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187088015",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070755",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070780",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099315",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099400",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152608",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416173",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416176",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416178",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988750",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988775",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615746",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615752",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615757",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999098300",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090085800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090108600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090134700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632300",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959029605",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700046700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700046800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003350",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003375",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919040132",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063375",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007101",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007150",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007175",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731801",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832501",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788903501",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042200",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189038532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226301",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506020",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090070900",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182500",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002801",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001401",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001405",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322800",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014730",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226401",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710220",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710230",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506101",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544043420",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544095006",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048800",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048802",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048807",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048814",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048820",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048821",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048828",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048830",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048860",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048890",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002920",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356098320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071200",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071400",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159500",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159502",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159600",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588000",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436002901",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436454301",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959066120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959066130",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002001320",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021014",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021028",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700068720",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002901",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002920",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001720",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013520",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036620",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629423701",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001501",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267130902",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716002",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835202",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897702",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518141301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219101",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219103",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219104",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003814",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003891",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003894",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006414",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006491",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006494",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189046320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789022401",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420013820",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226701",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226801",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710503",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710504",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710509",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710514",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710530",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046220",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046230",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046240",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046260",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002630",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002645",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002664",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358002684",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034104",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003300",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045400",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045401",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045405",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045500",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024619",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024621",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024630",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024640",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018206",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018209",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018214",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018230",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018240",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018290",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700033230",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864067530",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864067540",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919042430",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426301",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002230",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014030",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014040",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781194339",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781194382",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227773",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998150",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998175",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610246",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261042801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016347",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999035600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090593200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039332",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053350",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788715501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788800001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033443",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002655",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002675",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 250-62.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006547",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 250-62.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 250-62.5 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020407",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020410",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020415",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020407",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020410",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020415",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227973",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998250",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998275",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610446",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261046401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016447",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090092800",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090330900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090587300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217028601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039132",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187082600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053450",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053475",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033543",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867574",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867578",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985316",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985324",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613948",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613954",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613957",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261060001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090099600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217022001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700047125",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053875",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919069334",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085712",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085775",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053513",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682907",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829907",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997007",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003612",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003675",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205062075",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781187431",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016030",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050130",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227434",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781183101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781183120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714049401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261011220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016142",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598020614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070204",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070209",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070212",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070214",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070215",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070240",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084521",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084528",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084530",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700037520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864077730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135046220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187003206",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187003221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187080320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629423901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874122602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071006306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071006330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071154502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788996002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033611",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005394",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005794",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012630",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001406",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001421",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227534",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710803",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710804",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710830",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781185201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781185220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544095106",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634080771",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261011114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261011120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356098114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016242",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007706",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063037702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082103",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082105",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090231405",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436312901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070715",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070760",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002078920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076721",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700030620",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700044420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864076720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919043014",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919043020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066514",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135046320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001414",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042310",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187048814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187048820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874111202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071214",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071154602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071403202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071422402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071496702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788828302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788931902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788996102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033711",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222504",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222505",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222507",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222508",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226305",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003910",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003991",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003994",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008620",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011091",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011094",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934016291",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205065120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205071220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205071920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420052920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425018001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425018002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227034",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET CHEWABLE 200-28.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227234",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET CHEWABLE 400-57 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet Chewable 400-57 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115132901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228305911",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555078702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781233501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858061001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027810",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033788",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049825",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049895",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059502",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115133001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306311",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555079102",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781234301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858021501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027910",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033310",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033888",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059602",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115133101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306011",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555078802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781235201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028010",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033410",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033988",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050925",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050995",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115133201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306411",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555079202",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781236801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858032501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033510",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034088",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115133301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306111",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555078902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781237101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858093001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033610",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034188",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052025",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052095",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115132801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306211",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555079002",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858005501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027710",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884083901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033688",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059402",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185084201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097202",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289068060",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289068090",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064308",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064425",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064495",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013210",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077602",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064408",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077702",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064508",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185085301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097302",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064608",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013510",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185086401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097402",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781018001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064708",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013610",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185083101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097102",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806033901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289070030",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289070060",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289070090",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064108",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013010",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077502",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064208",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55150036501",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023301",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822105505",
      "ndc_label_name": "Amphotericin B Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440711640",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781214501",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781214505",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544012228",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003320",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003330",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003340",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999011720",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038920",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038928",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038930",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038940",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426601",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011401",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011403",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011407",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011410",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011420",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011421",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011424",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011425",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011428",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011430",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011440",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002528",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002530",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002540",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518260700",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005928",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340485",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340495",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781926185",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781926195",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940485",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940495",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013610",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010210",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011310",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323070408",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001810",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022202",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022241",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035101",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035110",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002100",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002110",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008602",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011415",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011441",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341215",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341292",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781941215",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781941292",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372501",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372511",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340946",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340995",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940946",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940995",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011599",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040400",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022415",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011899",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340078",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 125 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340095",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 125 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940178",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 125 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940195",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 125 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372001",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372010",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340880",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340895",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781927380",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781927395",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940880",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940892",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940895",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013720",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010310",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090455200",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011420",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002003",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002023",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022302",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022341",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035202",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002200",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008701",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008702",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011526",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011541",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042201",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001701",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001710",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341315",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341392",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781941315",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781941392",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323070508",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371901",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371910",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340278",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340295",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781924278",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781924295",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940278",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940295",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011110",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323070720",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022002",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022041",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035310",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035325",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008402",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011215",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011241",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371810",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340778",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340795",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925078",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925095",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940778",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940795",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013510",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010110",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011210",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323070800",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022102",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022141",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035010",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035050",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002400",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008501",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008502",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011315",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011341",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781303295",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014220",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021018620",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021010",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011620",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036820",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020602",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020641",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024102",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024141",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457034810",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008101",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008102",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000520",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000521",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002101",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002110",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409268901",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409268921",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611801",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781303446",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014499",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021018899",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011801",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011899",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037062",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020815",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024315",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457064910",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008301",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000775",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612301",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612310",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781303370",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781303395",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014330",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021018730",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567015010",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021110",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011720",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036920",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020702",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020741",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024202",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024241",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457034910",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008202",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000630",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000631",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002210",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409298703",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409298723",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115461101",
      "ndc_label_name": "Anagrelide HCl Capsule 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172524160",
      "ndc_label_name": "Anagrelide HCl CAPSULE 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668045301",
      "ndc_label_name": "Anagrelide HCl CAPSULE 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115462201",
      "ndc_label_name": "Anagrelide HCl Capsule 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172524060",
      "ndc_label_name": "Anagrelide HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668046201",
      "ndc_label_name": "Anagrelide HCl CAPSULE 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093753656",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904619546",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571042103",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003510",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003515",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003516",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261095700",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261095730",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261095760",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261095790",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008590",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038306",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038315",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090245300",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090245301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581200",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581201",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007511",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007515",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062010",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062033",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429028630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505298503",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011211",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011221",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135049030",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135049090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008018",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629526901",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629526905",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015504",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015508",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382020906",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382020910",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677403",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677406",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677409",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117000301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242000",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242001",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248400",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248401",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189041530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789000815",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789000890",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904053670",
      "ndc_label_name": "Animal Shapes/Iron Tablet Chewable 18 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00173086906",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173086910",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536104815",
      "ndc_label_name": "Antacid Calcium TABLET CHEWABLE 500 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023401",
      "ndc_label_name": "Antacid Extra Strength Tablet Chewable 160-105 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000043601",
      "ndc_label_name": "Antacid Ultra Strength Tablet Chewable 1000 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536199553",
      "ndc_label_name": "Anti-Dandruff SHAMPOO 1 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000046101",
      "ndc_label_name": "Anti-Diarrheal Capsule 2 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904772512",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000032301",
      "ndc_label_name": "Antifungal POWDER 2 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52083035260",
      "ndc_label_name": "Apetigen-Plus TABLET ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "27505000401",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27505000405",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817072001",
      "ndc_label_name": "Apomorphine HCl Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817072005",
      "ndc_label_name": "Apomorphine HCl Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232306",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232368",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059386",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058540",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058576",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232106",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232151",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059181",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059182",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058340",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058385",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781406336",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462011233",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232246",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232268",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059283",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059284",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059285",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059286",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058440",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058458",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058476",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904358",
      "ndc_label_name": "Apri TABLET 0.15-30 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904379",
      "ndc_label_name": "Apri TABLET 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090248100",
      "ndc_label_name": "Apri Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904025024",
      "ndc_label_name": "Aprodine Tablet 2.5-60 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63402020230",
      "ndc_label_name": "Aptiom TABLET 200 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020430",
      "ndc_label_name": "Aptiom TABLET 400 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020660",
      "ndc_label_name": "Aptiom TABLET 600 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020830",
      "ndc_label_name": "Aptiom TABLET 800 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597000302",
      "ndc_label_name": "Aptivus CAPSULE 250 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68176000017",
      "ndc_label_name": "Aqua-E Liquid 50.25 MG/ML (75 UT/ML) Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574003016",
      "ndc_label_name": "Aquabase Ointment External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58914021460",
      "ndc_label_name": "AquADEKs Solution Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58914001460",
      "ndc_label_name": "AquADEKs Tablet Chewable Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29978058890",
      "ndc_label_name": "Aquanaz PSE Tablet 60-20-375 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29978058701",
      "ndc_label_name": "Aquanaz TABLET 10-15-400 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959004050",
      "ndc_label_name": "Aquaphor OINTMENT EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00944281501",
      "ndc_label_name": "Aralast NP SOLUTION RECONSTITUTED 1000 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944281401",
      "ndc_label_name": "Aralast NP SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555906667",
      "ndc_label_name": "Aranelle TABLET 0.5/1/0.5-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555906679",
      "ndc_label_name": "Aranelle TABLET 0.5/1/0.5-35 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000101",
      "ndc_label_name": "Arcalyst Solution Reconstituted 220 MG Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73604091401",
      "ndc_label_name": "Arcalyst Solution Reconstituted 220 MG Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73604091404",
      "ndc_label_name": "Arcalyst Solution Reconstituted 220 MG Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595506",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595511",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595545",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595556",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756027702",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756027703",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462083335",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462083365",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016832",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016853",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016864",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016887",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015119",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015120",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015157",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015158",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748017530",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748017560",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748025730",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748025760",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061212",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061244",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061260",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061270",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002601",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002602",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50600054692",
      "ndc_label_name": "Arginine PACKET 500 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904421551",
      "ndc_label_name": "Arginine TABLET 500 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50600050267",
      "ndc_label_name": "Arginine2000 PACKET 2000 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54838057059",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651011055",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505040405",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089374",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689073505",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010020",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651161",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021805",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021830",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021890",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068110",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068130",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078501",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028001",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028010",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005303",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005308",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017713",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082730",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012407",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014705",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014715",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014745",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096730",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011710",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307300",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640901",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008915",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044830",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267408",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017901",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009930",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009931",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629700301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007410",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089803",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089809",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066305",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066330",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043201",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043203",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692101",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692102",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692103",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692109",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780801",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780802",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780803",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780806",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780809",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142101",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142102",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142103",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518276500",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282001",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282002",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047630",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015505",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015530",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018230",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651204",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021905",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021930",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021990",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068210",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068230",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014401",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028101",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028110",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005403",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005408",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017813",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082830",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012507",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096830",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011810",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269100",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282400",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009011",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009012",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044930",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267508",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019111",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019121",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010030",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010031",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007833",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089903",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089909",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066405",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066430",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043301",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043303",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700601",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700602",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700603",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700606",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700609",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250800",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250801",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256700",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256701",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518264300",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286900",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286901",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286902",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015605",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015630",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018330",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650904",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021605",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021630",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021690",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811067910",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811067930",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014101",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027801",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027810",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005103",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005108",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017513",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081930",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012207",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030203",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055430",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096530",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011510",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008712",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307503",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307508",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015721",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009730",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009731",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629701701",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739006933",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089603",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089609",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066105",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066130",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043003",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707601",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707602",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707603",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707606",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707609",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773302",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773303",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773306",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773309",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258400",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258401",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273600",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518295800",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335168201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015305",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015330",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651304",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022005",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022030",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022090",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068310",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068330",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014501",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028201",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028210",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005503",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005508",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017913",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082930",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012607",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014005",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014009",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014015",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014045",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096930",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011910",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009111",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009112",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045030",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267608",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020211",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020221",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010130",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010131",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090103",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090109",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066505",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066530",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043403",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706301",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706302",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706303",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706306",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706309",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251402",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518255700",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280600",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280601",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280602",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518301100",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518301101",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335041201",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335041202",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060901",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060902",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045530",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015705",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015730",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018430",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651404",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022105",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022130",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022190",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068410",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068430",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014601",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078801",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028301",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028310",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005603",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005608",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018013",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083030",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012707",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014815",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014845",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055930",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598097030",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433012010",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009211",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009212",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045130",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267708",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021311",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021321",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010230",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010231",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090203",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090209",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066605",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066630",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043503",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518130300",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256500",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282700",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282701",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297400",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297401",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015830",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018530",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651006",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651061",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904665640",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021705",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021730",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021790",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068010",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811068030",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078401",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027901",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027910",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005203",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005208",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017613",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082030",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012307",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018015",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018079",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011610",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583900",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008815",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700039930",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044730",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267308",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016801",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009830",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009831",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007010",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041310",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089703",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089709",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066205",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066230",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043103",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716202",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716203",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716206",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716209",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518097000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518126300",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518126301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253600",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282502",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518289700",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292100",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292102",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518295000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039230",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015405",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015430",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018130",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811069230",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040003",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073330",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010330",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033813",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010606",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010678",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811069330",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040103",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073430",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010430",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 15 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033913",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010706",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010778",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757050003",
      "ndc_label_name": "Aristada Initio Prefilled Syringe 675 MG/2.4ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65757040401",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040403",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040101",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040103",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040201",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040203",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040301",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040303",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309256",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343293",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803731",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991032390",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077030",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080630",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057102",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057107",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788003",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788006",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788009",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017803",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068101",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004130",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004160",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004190",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012690",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309356",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804531",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651004730",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862099830",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057202",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057207",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782603",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782606",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782609",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017903",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035330",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309456",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343393",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805331",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991032490",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700051030",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080730",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057302",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057307",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759303",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759306",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759309",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339018003",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130801",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184201",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013330",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026130",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006090",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309056",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343193",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781802931",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991032290",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080530",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180056907",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017703",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046430",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173087410",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 100 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173087414",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 100 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173087610",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 200 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173087614",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 200 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173088810",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 50 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536111825",
      "ndc_label_name": "Arthritis Pain Relieving Cream 0.075 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478006235",
      "ndc_label_name": "Artificial Tears Ointment 83-15 % Ophthalmic",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000001101",
      "ndc_label_name": "Artificial Tears Solution 0.5-0.6 % Ophthalmic",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478006012",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67157010151",
      "ndc_label_name": "Ascor Solution 25000 MG/50ML Intravenous",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001710",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036017",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036060",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762288801",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762288806",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332019931",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332019960",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991092817",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991092860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762109101",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762109106",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054410",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054460",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794001610",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762201201",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762201206",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332019831",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332019860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090209700",
      "ndc_label_name": "Ashlyna Tablet 0.15-0.03 &0.01 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462064691",
      "ndc_label_name": "Ashlyna TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462064693",
      "ndc_label_name": "Ashlyna TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904678370",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574703412",
      "ndc_label_name": "Aspirin SUPPOSITORY 300 MG Rectal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105429",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904404073",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035708",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093306406",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904705699",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714096401",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011660",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571027460",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598033960",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884000702",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407027160",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175033035",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559085060",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162059606",
      "ndc_label_name": "Aspirin-Dipyridamole ER CAPSULE EXTENDED RELEASE 12 HOUR 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040560",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436009205",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317210291",
      "ndc_label_name": "Assure ID Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317250291",
      "ndc_label_name": "Assure ID Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373072500",
      "ndc_label_name": "AsthmaPack for Children Kit",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093552606",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086001",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065360",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092060",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044403",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113606",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093552706",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086101",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065460",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017260",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071260",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044503",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113706",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093552856",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687504",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086201",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065530",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092230",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017330",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071330",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044602",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113803",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518136500",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283200",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075305",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075701",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075710",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717230",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150701",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150710",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522901",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522910",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017130",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017190",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041201",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041205",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041210",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261051700",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261051730",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261051760",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261051790",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003900",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003930",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014218",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014245",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014250",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353088760",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098660",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341000",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341003",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341005",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090526600",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090526603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631100",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631103",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631105",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068501",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068520",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025830",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025860",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113800",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113803",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113806",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217023730",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217023790",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066130",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066190",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864071730",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002610",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002690",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919085430",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919085490",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062310",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262601",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262602",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262604",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038801",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038807",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038810",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038812",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038815",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038820",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874038830",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043901",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043910",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017001",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017099",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002930",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002960",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002990",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002991",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002992",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544033260",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002401",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002410",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645001",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645003",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645006",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645009",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707101",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707103",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707106",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707109",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088200",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088202",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293900",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293901",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293902",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189015290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028300",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078701",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021810",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717090",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781107801",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781107810",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522001",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522010",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718761",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544016790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571043011",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041001",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041005",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041010",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003700",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014010",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014018",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014090",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080501",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080530",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080590",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095230",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095290",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083330",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083345",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083360",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083380",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045400",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045410",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045460",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045490",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051402",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051404",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051405",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341104",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540802",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540805",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075901",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075920",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046301",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046330",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046360",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110800",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110803",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110806",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018130",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018190",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700056630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075530",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864074930",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864074990",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002790",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060511",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760006090",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016390",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760025690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760043730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760043790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760078790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027930",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027960",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027990",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919091471",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187053710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062101",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062110",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178502",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178503",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046801",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046810",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046814",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046815",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046820",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046830",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046860",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874046890",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043701",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043710",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243034709",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016899",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267003030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267003060",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544016130",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544016145",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544016160",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544016180",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544016192",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024060",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024080",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024092",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002201",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002210",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788736801",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788736803",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788736806",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788736809",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778401",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778403",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778409",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787601",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787603",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787606",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787609",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518039900",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518039902",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300700",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934017730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934017760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205009690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065830",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065845",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065860",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065880",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065892",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014660",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189039690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023101",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023110",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717106",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717192",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150610",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522501",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522510",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544012730",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544058630",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544058690",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571043111",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041105",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261034900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261034930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261034960",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261034990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003800",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003830",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358003860",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073730",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014118",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076590",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083060",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083073",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083445",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083460",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083473",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083480",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093945",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093960",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093973",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093980",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044204",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044207",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044208",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090281100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304307",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090523308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536708",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574104",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574107",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574108",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068401",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068420",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068463",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025300",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025320",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025330",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025340",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100400",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100403",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100406",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489052910",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348014230",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022803",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022860",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289022890",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864006501",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864006530",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002510",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002590",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760005930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760005990",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064330",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064390",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025730",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025790",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919093530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919093590",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020130",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033202",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033207",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033210",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033214",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033215",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033220",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033260",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874033290",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043801",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043810",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243001403",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243001409",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243001418",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243001445",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030803",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030809",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030818",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016901",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016999",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267003130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267003160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032615",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032630",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032645",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032660",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032673",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544032680",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002301",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002310",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645049354",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645058554",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645801",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645803",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645806",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788645809",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761603",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761606",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761609",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035102",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037901",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037902",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518286600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303602",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934021930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049630",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013530",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378206401",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591578301",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073401",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714093701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300040101",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289098830",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518244600",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710116801",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954039110",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378206301",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591578201",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073301",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714093601",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300040001",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094200",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094230",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094260",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261094290",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014909",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098509",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099330",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099360",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099390",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710116701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954039010",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000032201",
      "ndc_label_name": "Athletes Foot Powder Spray Aerosol Powder 1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000032101",
      "ndc_label_name": "Athletes Foot Powder Spray Aerosol Powder 2 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113015473",
      "ndc_label_name": "Athletes Foot Spray Aerosol 1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093354256",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075501",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041530",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111051930",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283003",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037303",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026530",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354856",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076101",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042130",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614400",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010630",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056430",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283603",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037903",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004630",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027130",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354356",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075601",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041630",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010130",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052030",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283103",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037403",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004130",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026630",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354456",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075701",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041730",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005713",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052830",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283203",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056721",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037503",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026730",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354556",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690804",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075801",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041830",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614300",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628900",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005811",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005813",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052130",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283303",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032625",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032695",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037603",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026830",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354656",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075901",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041930",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090625400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005911",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005913",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052230",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283403",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037703",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026930",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354756",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076001",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042030",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612700",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010530",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056330",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283503",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037803",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004530",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027030",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505698",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395005",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395077",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712581",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712585",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538192",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629061",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004417",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261095900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261095930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261095960",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261095990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356086018",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356086030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356086090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063047430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090549701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009311",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009315",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020820",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012190",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154663500",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015501",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015502",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257808",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257809",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090390",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089043",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089046",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629846901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739001810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009711",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024916",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045854",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048054",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788686201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788686203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788686206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788686209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788955603",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089705",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089715",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002713",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518022402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016902",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016904",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399051001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399061001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016960",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002299",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025550",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505998",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395177",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712681",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712685",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538292",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629161",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004517",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097260",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097299",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356089418",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356089430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356089490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049660",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090488001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009411",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009415",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436998803",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020920",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655092152",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020960",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020999",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012290",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154663400",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015601",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015602",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257908",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257909",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089143",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089146",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629803201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629803202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739002010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091530",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009811",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025016",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045954",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048154",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048254",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059154",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788968303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089805",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089812",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094505",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094512",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002813",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518018602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518087800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518087803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518332600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518341400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105104",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399052005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399062005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002260",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002399",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025650",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505898",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395277",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712781",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712785",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538492",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629261",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004617",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356092930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018215",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018260",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095915",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095945",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009511",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009515",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436998901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021001",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021020",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458088116",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012390",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154664600",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015702",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258008",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258009",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089241",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089246",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187010990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739003610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009911",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025116",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645046054",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048354",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056854",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059254",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089905",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089915",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094605",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002913",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518327300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205026490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205073130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399054001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399064001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016815",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016845",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002499",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025750",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505798",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00179014145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395377",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712881",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712885",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538892",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629304",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004716",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261099530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261099560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261099590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017510",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081579",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082753",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009611",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009612",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217031930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217031990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012490",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154438406",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700003430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015802",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267108",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089741",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089746",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090790",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739003733",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059025",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059095",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025216",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645046154",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645049554",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899101",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899106",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097091105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097091112",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094705",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094712",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377003012",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377003014",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518151400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518151401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058301",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058302",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399068005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002599",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025850",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": true,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121088818",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121088842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089805",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089818",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179610",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179620",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706425",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706453",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702022321",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090001",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722062921",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008611",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008612",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053440",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053478",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162069388",
      "ndc_label_name": "Atovaquone SUSPENSION 750 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006218",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006242",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993006272",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180028201",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042121",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042169",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452025287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748029901",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378416201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704001",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704065",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544090905",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544090910",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261090001",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039314",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039320",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052207",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052214",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052220",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052224",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052268",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052269",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052273",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130200",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130201",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130202",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130203",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130204",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130205",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130206",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130207",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130208",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130209",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298000",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298001",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298002",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298003",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298004",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298005",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298006",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298007",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298008",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298009",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118040402",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049804",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049811",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049813",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087924",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993006002",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993006027",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024500",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024514",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024515",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040401",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040444",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040467",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378416001",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59088044605",
      "ndc_label_name": "Atrix Medicated Formula Cream 2 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59088071300",
      "ndc_label_name": "Atrix System 1 Kit 2 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00065081701",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065081702",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090310400",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629500",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219174802",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219174903",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219175008",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622600",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622601",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622602",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260000101",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597008717",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096100",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021001",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021002",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021004",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021101",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021102",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021104",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50102022021",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102022023",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093921",
      "ndc_label_name": "Aurovela 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093988",
      "ndc_label_name": "Aurovela 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093487",
      "ndc_label_name": "Aurovela 24 FE Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093488",
      "ndc_label_name": "Aurovela 24 FE Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094187",
      "ndc_label_name": "Aurovela Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094188",
      "ndc_label_name": "Aurovela Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094087",
      "ndc_label_name": "Aurovela FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094088",
      "ndc_label_name": "Aurovela FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546017260",
      "ndc_label_name": "Austedo TABLET 12 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546017060",
      "ndc_label_name": "Austedo TABLET 6 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546017160",
      "ndc_label_name": "Austedo TABLET 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81968004530",
      "ndc_label_name": "Auvelity Tablet Extended Release 45-105 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555904558",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904579",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187088928",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378614144",
      "ndc_label_name": "Avita CREAM 0.025 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378614145",
      "ndc_label_name": "Avita CREAM 0.025 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00225038180",
      "ndc_label_name": "Ayr Nasal Mist Allergy/Sinus SOLUTION 2.65 % NASAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00225038280",
      "ndc_label_name": "Ayr Saline Nasal Drops SOLUTION 0.65 % NASAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65862084828",
      "ndc_label_name": "Ayuna Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084888",
      "ndc_label_name": "Ayuna Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064011030",
      "ndc_label_name": "Ayvakit Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72064012030",
      "ndc_label_name": "Ayvakit Tablet 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72064012530",
      "ndc_label_name": "Ayvakit Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72064013030",
      "ndc_label_name": "Ayvakit Tablet 300 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72064015030",
      "ndc_label_name": "Ayvakit Tablet 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143960601",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781325394",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925394",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057801",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714077701",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714092701",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030610",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598014362",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598030562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598046562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067811",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079798",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039301",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323077139",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009601",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009602",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025430",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001031356",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001050454",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052754",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097080540",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121123701",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011530",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015395",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020101",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606055801",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378100501",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261075800",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261075830",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261075860",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261075890",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007101",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074509",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074560",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079062001",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079062006",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407018201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219107601",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049301",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049305",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022901",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022911",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000301",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000305",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462050201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610012409",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030660",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012930",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115162456",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591213155",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781717250",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672138903",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462062652",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478071810",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093890",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057804",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314030802",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050606",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069009101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054029399",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009430",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015330",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335077991",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233000",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090253800",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51525029403",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991081403",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505083305",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629205701",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044930",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802002683",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.15 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383094230",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51525023403",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651021530",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505084805",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.15 % NASAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251901",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162070684",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356048701",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305101",
      "ndc_label_name": "Azithromycin PACKET 1 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305102",
      "ndc_label_name": "Azithromycin PACKET 1 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305105",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014410",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014411",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014421",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150017410",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505607604",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051240",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051244",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039810",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039812",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039814",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457086000",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457086050",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002501",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002502",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001982",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010010",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010041",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012541",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012566",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202723",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261073601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356004415",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806014731",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386047060",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186800",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249100",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000715",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762311001",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152705",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788732001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788822901",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145701",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202623",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202631",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202694",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070632",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070834",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261047201",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261091901",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356019915",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356019930",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806014932",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806015033",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806015134",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386047161",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090098300",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090098400",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183500",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250900",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622600",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090626700",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420005",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420007",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093215",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093230",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700021130",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073130",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078415",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000815",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000823",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000830",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762312001",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762313001",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762314001",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038230",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152805",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730703",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754903",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788822203",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788995903",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145802",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145902",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146002",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205021630",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056615",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717502",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717504",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527237032",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577626",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577631",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577669",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808926",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808931",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670861",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904735006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069503",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069516",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069581",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013910",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013918",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261013930",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063072802",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063072804",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069387",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090095800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090178800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090178801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090321300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090338500",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090338501",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460100",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472000",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472001",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078751",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078766",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007411",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007413",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007415",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009811",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009815",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436078701",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436149601",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436435601",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436435701",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002218",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002250",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002260",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083806",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002222404",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002222806",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217016001",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217017301",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217026301",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700006506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700020606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035106",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700043206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700043266",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700070506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118078706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219803",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219807",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762306001",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762306002",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762306003",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687074211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687074265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760050206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760080806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919017006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036206",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919055506",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025118",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187000704",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187000706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187016906",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187028406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187060406",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629267301",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874119706",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096101",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096105",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064163",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064169",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067001",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067003",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067005",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067006",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067018",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039204",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071132306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016011",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016013",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086111",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788765406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788810106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788812406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788893906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788952906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997706",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017113",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017173",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677012906",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518073600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518078401",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518080300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243301",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243302",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243303",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256200",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518270800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518321700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205011904",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015866",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042706",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043004",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000187",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008102",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789017030",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021901",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "XXXMSXXXX30",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL (6 PACK)",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527239532",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781578903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781578931",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809031",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904690904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904735104",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261087901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004110",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356079803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008330",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054002",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054005",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054007",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054079",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071302",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071303",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071305",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071307",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071379",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165501",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090240700",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090413201",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090470000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078810",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078855",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078867",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007611",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007612",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009911",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009913",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012250",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959092703",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002004703",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217016101",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348085702",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700089603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762307001",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762307002",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027111",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027121",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919077603",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096401",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096405",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064264",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064290",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065301",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065303",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065305",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065306",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065319",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071077405",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016106",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016113",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086206",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086211",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788708203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788708205",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788759803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788812503",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788894703",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788894705",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788907803",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788952103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017213",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017272",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017274",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059902",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059905",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059906",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316802",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325402",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205019603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205051903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189001502",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009002",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006302",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006602",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006607",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006679",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016930",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425022001",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "XXXMSXXXX50",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL (3 pack)",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093714756",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781579331",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809131",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008430",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078910",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224022230",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762308001",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031425",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031495",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442040330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096201",
      "ndc_label_name": "Azithromycin TABLET 600 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016206",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086306",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017313",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518071300",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518324900",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409082901",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409082911",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040101",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040120",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040124",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040126",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040141",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409083001",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409083011",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040201",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040203",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040220",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040224",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040230",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040241",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007201",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007206",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862089001",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862089006",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74312000530",
      "ndc_label_name": "B-Complex/Folic Acid/Vitamin C Tablet Extended Release Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205042278",
      "ndc_label_name": "B-Complex/Vitamin C (w/ Ca) Tablet Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017735",
      "ndc_label_name": "Baby Vitamin D3 Liquid 10 MCG /0.028ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478071935",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208078555",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC OINTMENT 1 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999065335",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC OINTMENT 1 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959023803",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC OINTMENT 1 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267095535",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC OINTMENT 1 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536125628",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574402235",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472110534",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24208055555",
      "ndc_label_name": "Bacitracin-Polymyxin B OINTMENT 500-10000 UNIT/GM OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090327400",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267092535",
      "ndc_label_name": "Bacitracin-Polymyxin B OINTMENT 500-10000 UNIT/GM OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788759903",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189001735",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409680",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440718030",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133001",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133010",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240621",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240628",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240632",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102410",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102450",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105410",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105411",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105415",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904647561",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053201",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053210",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017290",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007104",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007106",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001002",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001007",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001014",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001015",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001020",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001021",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001030",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001060",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001090",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001099",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004230",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060700",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060701",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060730",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060745",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060760",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060790",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585503",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614903",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010611",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010615",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436006001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902201",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902202",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902203",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902205",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032010",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032050",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073300",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073302",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073310",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073312",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073318",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073320",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073330",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073340",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073360",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154763500",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040360",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039405",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039499",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050311",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002630",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002690",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009314",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009360",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009372",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009386",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047305",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014778",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031330",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031360",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031372",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031378",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128605",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128607",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739047910",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062004",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062010",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062020",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062030",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062040",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062060",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874062090",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061730",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061760",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061790",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067180",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067192",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085511",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764306",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764308",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764309",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818103",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818106",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818108",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818109",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788984603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788984606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788984609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036200",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128505",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028811",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028812",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047414",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047420",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047472",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047478",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020600",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020601",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020602",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020603",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020604",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020605",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020606",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020607",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020608",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020609",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034402",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034403",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034404",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034405",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034406",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034407",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034408",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034409",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164302",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179701",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179702",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179704",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179707",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045280",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045292",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066060",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066080",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066092",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000612",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000613",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001005",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000204",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024130",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024190",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008002",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015602",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001530",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001560",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001590",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409760",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409780",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440718130",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133701",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133705",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133710",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240721",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240728",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240732",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102500",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102510",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832102550",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105510",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105511",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105515",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904647661",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053301",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053305",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053310",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007204",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007205",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034410",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099905",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099910",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004330",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004360",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004390",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073630",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073660",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073690",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086530",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086560",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086590",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583802",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583803",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010711",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010715",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902301",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902302",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902303",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032110",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032150",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067702",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067710",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067730",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067745",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067760",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067790",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700023630",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039505",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039599",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687051401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687051411",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002730",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009530",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009560",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009586",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009590",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047405",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047490",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739048010",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102500",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102502",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102504",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874102509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087260",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087291",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084086801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084086811",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638401",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638403",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638406",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638408",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638409",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788690301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788690303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788690306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788690308",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788690309",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756206",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756208",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756209",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833308",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833309",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518217300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266200",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518311500",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518311501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128600",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128605",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028911",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028912",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028951",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094900",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335166401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039145",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039160",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039192",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044645",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044660",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044692",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000712",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000713",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789031230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789031290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001105",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000302",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000304",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024260",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425011201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425011202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020502",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054007928",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015728",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010211",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010213",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429095228",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257507",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682075002",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014969",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676003056",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676003084",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676004028",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676004056",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676005028",
      "ndc_label_name": "Balversa Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903458",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903479",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003161412",
      "ndc_label_name": "Baraclude SOLUTION 0.05 MG/ML ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002771501",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002771559",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00052060301",
      "ndc_label_name": "BCG Vaccine Solution Reconstituted 50 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00052060302",
      "ndc_label_name": "BCG Vaccine Solution Reconstituted 50 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290823000",
      "ndc_label_name": "BD Glucose TABLET CHEWABLE 5 GM ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00006003310",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006003330",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006032510",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006032530",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006033510",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006033530",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006000510",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006000530",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185005301",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185005305",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378044301",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781189201",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544056630",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544056690",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811062810",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811062850",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075001",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075005",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261017930",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261017960",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261017990",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004830",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016101",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016150",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067930",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067990",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033610",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033650",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091202",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090377500",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090377502",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575102",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011011",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011015",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014501",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014520",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046301",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046305",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084130",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084160",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217019030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075205",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033808",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033809",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015990",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760008190",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760035190",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028030",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028060",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033801",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033805",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075210",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075250",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011601",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518025200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518025201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518307400",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335085401",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335085404",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185082001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185082005",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378044401",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719230",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719290",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544055430",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544055490",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811062950",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075101",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075105",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018002",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018030",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018060",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018090",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004930",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016201",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016250",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063040330",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067730",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033703",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033710",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033750",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999075930",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011111",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011115",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014601",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014620",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046401",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046405",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083130",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075305",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458086316",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029130",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029190",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033908",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033909",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429016001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429016090",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760035290",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073990",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039330",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039390",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033901",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033905",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874112301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874112303",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075310",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075350",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011701",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014630",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014660",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014690",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014691",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518164000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518164001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317200",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934022890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934060830",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934060890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378044701",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719330",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719390",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811063010",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811063050",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075201",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075205",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084600",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084630",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084660",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084690",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016301",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016350",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063074830",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063078730",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033803",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033810",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033850",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091400",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090335900",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090335901",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011211",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011215",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046505",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083530",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083560",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075405",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458086216",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031730",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031790",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118034003",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118034009",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919075690",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304034001",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304034005",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075410",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075450",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011801",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002660",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695701",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695703",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695706",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695708",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695709",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724801",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724803",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724806",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724808",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724809",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784503",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784506",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784508",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784509",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518212500",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518212501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317100",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934054530",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205032030",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185050501",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185050505",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378044101",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781189101",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811062710",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058730",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058760",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058790",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016001",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016050",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033510",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010911",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010915",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046201",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046205",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007630",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007660",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007690",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075101",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075105",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033703",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033709",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015890",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033701",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629267901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075110",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075150",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185032501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378473501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832048311",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045330",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045360",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261045390",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358004730",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429040401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505026201",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629180901",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629180902",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019401",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185021101",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378474501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022901",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832048411",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429040501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505026301",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268001",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268002",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268003",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185027701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378477501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022801",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832048511",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005030",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959090730",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429040601",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505026401",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019601",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185023601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378472501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429040301",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505026101",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459034804",
      "ndc_label_name": "Bendeka SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008801",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401008802",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401008835",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401008861",
      "ndc_label_name": "Benlysta Solution Auto-Injector 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401008842",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401008847",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49401010101",
      "ndc_label_name": "Benlysta SOLUTION RECONSTITUTED 120 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401010201",
      "ndc_label_name": "Benlysta SOLUTION RECONSTITUTED 400 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00225061023",
      "ndc_label_name": "Benzedrex INHALER NASAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00187019410",
      "ndc_label_name": "BenzEFoam Foam 5.3 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395024392",
      "ndc_label_name": "Benzoin Compound TINCTURE External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452100002",
      "ndc_label_name": "Benzoin TINCTURE EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904656460",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057401",
      "ndc_label_name": "Benzonatate CAPSULE 150 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722095801",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67405083506",
      "ndc_label_name": "Benzoyl Peroxide Cleanser Liquid 6 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802030801",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802010196",
      "ndc_label_name": "Benzoyl Peroxide Gel 2.5 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802021601",
      "ndc_label_name": "Benzoyl Peroxide GEL 5 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126163",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802028001",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00781705449",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781709459",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980032801",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980032802",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682090023",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin Gel 5-3 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682090146",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143923301",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923305",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143972901",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143972905",
      "ndc_label_name": "Benztropine Mesylate SOLUTION 1 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478001202",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323097002",
      "ndc_label_name": "Benztropine Mesylate SOLUTION 1 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382086002",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382086010",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243321",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243332",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243721",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243732",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904678861",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060610",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353070709",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353091309",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035611",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629960501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038111",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082607",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072000",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072001",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072002",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518168800",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518168801",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169102",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169103",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169104",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273200",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273202",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010301",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010310",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719530",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719560",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719590",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719592",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243421",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243432",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243821",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243832",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904679061",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060710",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018130",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018160",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353058030",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353058053",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353079630",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353079653",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090311600",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090602200",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864005506",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687036801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687036811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014418",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014457",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187084003",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060010",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060014",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060015",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060020",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060030",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874060060",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082707",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082715",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057700",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057800",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088100",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610050253",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010401",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010410",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719630",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719660",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719690",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719692",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243521",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243532",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243921",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243932",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904678961",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060801",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060810",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090269500",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864005630",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687037901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687037911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919012830",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014210",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014218",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014257",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213401",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629942201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056512",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056515",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056520",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056530",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874056560",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083207",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083215",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267700",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267701",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010501",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010510",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102003",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552085905",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63833082502",
      "ndc_label_name": "Berinert KIT 500 UNIT Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208044605",
      "ndc_label_name": "Besivance SUSPENSION 0.6 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090124100",
      "ndc_label_name": "Besivance Suspension 0.6 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118999305",
      "ndc_label_name": "Besivance SUSPENSION 0.6 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152905",
      "ndc_label_name": "Besivance SUSPENSION 0.6 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73536050001",
      "ndc_label_name": "Besremi Solution Prefilled Syringe 500 MCG/ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54629010302",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618018012",
      "ndc_label_name": "Betadine Antiseptic Cream 5 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618016003",
      "ndc_label_name": "Betadine SOLUTION 5 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618015101",
      "ndc_label_name": "Betadine Surgical Scrub Solution 7.5 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618015303",
      "ndc_label_name": "Betadine Swabsticks SWAB 10 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00713035281",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55792000201",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011518",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72647090001",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026515",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026550",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802037632",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802037635",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090209100",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327000",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523200",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131001",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131003",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012450",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217004201",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861401",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029017",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029052",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724105",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767005",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027515",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356064115",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999075715",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130901",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130903",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026730",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026760",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672134003",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672134004",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565002329",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565002359",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118999503",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118999506",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748048030",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748048060",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026815",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026850",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038215",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038245",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565001915",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565001951",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739099665",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089749",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180094701",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180094702",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005515",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005546",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038015",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038045",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099601",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099602",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059501",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261072901",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023500",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037300",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183900",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218200",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327600",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090403800",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027315",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027345",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127401",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127406",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072115",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072145",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094163",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094167",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123301",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123304",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005760",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072853",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713080753",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802002146",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748047560",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005615",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005646",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038115",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038145",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356049615",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802050514",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802050584",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023600",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817082415",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817082445",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026200",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026215",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096250",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002072363",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002072367",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217002901",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217010401",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629932301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629932401",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267129601",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009306",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004015",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004046",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037015",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037045",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032615",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032637",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904077645",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261039801",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261086301",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030901",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126901",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126906",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026300",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026301",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092163",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092167",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267098415",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731201",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731204",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518313700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004015",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004160",
      "ndc_label_name": "Betamethasone Valerate LOTION 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024303",
      "ndc_label_name": "Betamethasone Valerate LOTION 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879000460",
      "ndc_label_name": "Betamethasone Valerate LOTION 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168003315",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168003346",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037115",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037145",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032715",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032737",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002084563",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782701",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782704",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036415",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419052401",
      "ndc_label_name": "Betaseron KIT 0.3 MG Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419052435",
      "ndc_label_name": "Betaseron KIT 0.3 MG Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478070510",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478070511",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024501",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024502",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024503",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527134001",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051100",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051101",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051189",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051601",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111032401",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011311",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011315",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057201",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068901",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068911",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016101",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057210",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084036501",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084036511",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335084601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527135601",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051200",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051201",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051289",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617861",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051701",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051705",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111032501",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011411",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011415",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064701",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057301",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289017712",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429034201",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429034218",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687070001",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687070011",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016201",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057310",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070411",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133201",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051000",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051501",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111032301",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064501",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057101",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700038230",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429034001",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202201",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016001",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057110",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527132901",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051300",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051301",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051389",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051801",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111032601",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064801",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057401",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429034301",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429034318",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202501",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016301",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057410",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065024610",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065024615",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072910",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072915",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310460012",
      "ndc_label_name": "Bevespi Aerosphere Aerosol 9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310460039",
      "ndc_label_name": "Bevespi Aerosphere Aerosol 9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054039925",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378695501",
      "ndc_label_name": "Bexarotene CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591283201",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832028500",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007201",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292000701",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292000710",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975031510",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682000310",
      "ndc_label_name": "Bexarotene CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238125001",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682000260",
      "ndc_label_name": "Bexarotene Gel 1 % External",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238208806",
      "ndc_label_name": "Bexarotene Gel 1 % External",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160097602",
      "ndc_label_name": "Bexsero Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160097620",
      "ndc_label_name": "Bexsero Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904601946",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057101",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057102",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714081601",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714081602",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729002301",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729002310",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335048583",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335048588",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017701",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017705",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017730",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505264201",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505264203",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175013232",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559089030",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518299300",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518299301",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090101600",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090101601",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587700",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587701",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070102",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070110",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070204",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 2400000 UNIT/4ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070210",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 2400000 UNIT/4ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587600",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070001",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070010",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250501",
      "ndc_label_name": "Biktarvy Tablet 30-120-15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624700",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250101",
      "ndc_label_name": "Biktarvy TABLET 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250103",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308000",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308001",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308002",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80053000049",
      "ndc_label_name": "Bio-D-Mulsion Forte Liquid 50 MCG/0.04ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80053000048",
      "ndc_label_name": "Bio-D-Mulsion Liquid 10 MCG/0.04ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "26608000150",
      "ndc_label_name": "Bio-K Plus Strong Capsule Delayed Release Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "26608001202",
      "ndc_label_name": "BiomePro Liquid Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131092882",
      "ndc_label_name": "Biotin CAPSULE 1 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312051697",
      "ndc_label_name": "Biotin CAPSULE 10 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604042546",
      "ndc_label_name": "Biotin Capsule 2500 MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312013430",
      "ndc_label_name": "Biotin CAPSULE 5 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552065404",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45737021516",
      "ndc_label_name": "Biovol Syrup Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904640761",
      "ndc_label_name": "Bisacodyl EC TABLET DELAYED RELEASE 5 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574705012",
      "ndc_label_name": "Bisacodyl SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00185077401",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185077430",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378052401",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378052493",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714053001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714053002",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012713",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064601",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064630",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027110",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027130",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060430",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060431",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008730",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045610",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045620",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011206",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009301",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185077101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185077130",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378052301",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378052393",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052902",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012613",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999086600",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012711",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012715",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064501",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064530",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027010",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027030",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067911",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067921",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078790",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060331",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087190",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008630",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677501",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677503",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677506",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788677509",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045510",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045520",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011106",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009230",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324356",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185070701",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185070705",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185070730",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050501",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050505",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074205",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074230",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018901",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018905",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018913",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092202",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063013430",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063013490",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090079900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090590500",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090603000",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024130",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088030",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194701",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518320700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041410",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041430",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041440",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050110",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017330",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018701",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018705",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018713",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092001",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092002",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063013590",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090079600",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090647800",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087801",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087805",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087830",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041210",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041240",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050301",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050305",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050310",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074101",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018801",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018805",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018813",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261091830",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261091860",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261091890",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092102",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092130",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078902",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090584900",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090584902",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641302",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959033710",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959033730",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289063030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289063090",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864078430",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629407201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087901",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087905",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087930",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041310",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041330",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041340",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650301",
      "ndc_label_name": "Bivigam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650302",
      "ndc_label_name": "Bivigam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59730650201",
      "ndc_label_name": "Bivigam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650201",
      "ndc_label_name": "Bivigam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650202",
      "ndc_label_name": "Bivigam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086411",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086413",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086471",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086473",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086611",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086613",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086671",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086673",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183100",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084201",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084211",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137700",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569644000",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569644001",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084205",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084234",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Brand",
      "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": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409170401",
      "ndc_label_name": "Bortezomib Solution Reconstituted 1 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409170301",
      "ndc_label_name": "Bortezomib Solution Reconstituted 2.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909801",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409170001",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019099101",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024410",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598042660",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742048401",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033701",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505605004",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082110",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053436",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054036",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054136",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710141101",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860022510",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011810",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205018301",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598086560",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072110",
      "ndc_label_name": "Bortezomib SOLUTION RECONSTITUTED 3.5 MG Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054052121",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591251260",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10148012560",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335003986",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005902",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162087406",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044714",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054052021",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591251160",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10148062560",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335003886",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005802",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162087306",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044614",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069013501",
      "ndc_label_name": "Bosulif Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019301",
      "ndc_label_name": "Bosulif Tablet 400 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069013601",
      "ndc_label_name": "Bosulif Tablet 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192030160",
      "ndc_label_name": "BP Vit 3 CAPSULE 1 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192016160",
      "ndc_label_name": "BPO Foaming Cloths 6 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70255002501",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002502",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002503",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002504",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173085910",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173085914",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518202800",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173088210",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173088214",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569666500",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310461612",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310461628",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310461639",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031629",
      "ndc_label_name": "Briellyn TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031684",
      "ndc_label_name": "Briellyn Tablet 0.4-35 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077660",
      "ndc_label_name": "Brilinta TABLET 60 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077708",
      "ndc_label_name": "Brilinta TABLET 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077739",
      "ndc_label_name": "Brilinta TABLET 90 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077760",
      "ndc_label_name": "Brilinta TABLET 90 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154961800",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154961808",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056401",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056402",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056403",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014405",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014410",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014415",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879201",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077305",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077310",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077315",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071511",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071512",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041105",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041110",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041115",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104600",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636800",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014305",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014310",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014315",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023101",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023201",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023301",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018505",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018515",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591212712",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591212779",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781601470",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781601485",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879301",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682046410",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682046415",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474087015",
      "ndc_label_name": "Briviact SOLUTION 10 MG/ML ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474097063",
      "ndc_label_name": "Briviact SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474097075",
      "ndc_label_name": "Briviact SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474037066",
      "ndc_label_name": "Briviact TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474077009",
      "ndc_label_name": "Briviact TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474077066",
      "ndc_label_name": "Briviact TABLET 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474047009",
      "ndc_label_name": "Briviact TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474047066",
      "ndc_label_name": "Briviact TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474057009",
      "ndc_label_name": "Briviact TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474057066",
      "ndc_label_name": "Briviact TABLET 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474067066",
      "ndc_label_name": "Briviact TABLET 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383024971",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050817",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862078917",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014201",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378709601",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378709693",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304015801",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304015830",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382011001",
      "ndc_label_name": "Bromocriptine Mesylate Capsule 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382011006",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378204201",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378204293",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574010601",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574010603",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781532501",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781532531",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028611",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028621",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096201",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096230",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708075441",
      "ndc_label_name": "BromSite SOLUTION 0.075 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838013640",
      "ndc_label_name": "Brotapp DM Liquid 15-1-5 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72579001102",
      "ndc_label_name": "Brukinsa Capsule 80 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093744501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574985510",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082901",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002003",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407012801",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862058001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862058201",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059090",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429026401",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059632",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059633",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980025501",
      "ndc_label_name": "Budesonide CAPSULE DELAYED RELEASE PARTICLES 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162077810",
      "ndc_label_name": "Budesonide CAPSULE DELAYED RELEASE PARTICLES 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382072001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378450093",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591251030",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407022430",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036630",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629909301",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682030930",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681519",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681545",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681555",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681573",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168774",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168776",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487960101",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487960130",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751514",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751587",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001805",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001830",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335063149",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788702003",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788729003",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842903",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031832",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031853",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031886",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031887",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064037",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064038",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681619",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681645",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681655",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681673",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168974",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168976",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487970101",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487970130",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751614",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751687",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001905",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001930",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335063249",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052479",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052483",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180098405",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180098430",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788376803",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788679603",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731403",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031932",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031953",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031986",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031987",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001801",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064137",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064138",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00774031777",
      "ndc_label_name": "Bull Frog Mosquito Coast Liquid External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00409141204",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141210",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141234",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141240",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600701",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600710",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600801",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600810",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616101",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616110",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616201",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616210",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057001",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057004",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057201",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057210",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462046940",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462046954",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462047040",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462047054",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040504",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040541",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040610",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040641",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010101",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010107",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010201",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010207",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004001",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004010",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004101",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004110",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012801",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012805",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054011",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070001",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070005",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083101",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799011901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566400",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090630800",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013011",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013015",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052501",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238148901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012901",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012905",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054111",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701606",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701661",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070101",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070105",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083201",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083202",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098300",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098330",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098360",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098390",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012001",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012002",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028809",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028874",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090613802",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090634502",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013111",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013115",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038401",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038411",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038425",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038465",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038495",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052605",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149001",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149005",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001603",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185013001",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185013005",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720230",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054211",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070201",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070205",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083301",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083302",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012101",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012102",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353029216",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566300",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090630400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013215",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053501",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053511",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052705",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149101",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149105",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267800",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518319100",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054017613",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315603",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378092393",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715404",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858050103",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383092493",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700030230",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048111",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048121",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756045983",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629947501",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518221700",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222600",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222601",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222602",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222603",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095001",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095002",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095003",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054017713",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315303",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378092493",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715504",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356055630",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858050203",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157100",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383093093",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217024630",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700030330",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049211",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049221",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756046083",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518162500",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518201400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518201401",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518221800",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335115401",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335115402",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335115403",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116301",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116302",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116303",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876816",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876893",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781724906",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781724964",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058101",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058130",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035803",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035811",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427071203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427071211",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876516",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876593",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781721606",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781721664",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598057901",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598057930",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035511",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069211",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876616",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876693",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781722706",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781722764",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058001",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058030",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035611",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069411",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876716",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876793",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781723806",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781723864",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058201",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058230",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035703",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035711",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069803",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069811",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054018813",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315473",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406192303",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406800503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700906",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729054910",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291017430",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858060103",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014411",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014415",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383029493",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090130",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058630",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058633",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062611",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062665",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175045232",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756096983",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629948201",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162041603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518100700",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335129601",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054018913",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315567",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315573",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406192403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406802003",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904701006",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729055010",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291017530",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858060203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383028793",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862060830",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217013830",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058730",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058733",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063711",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063765",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175045832",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756097083",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629948301",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162041503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518231100",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518312900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335137801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172501",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172502",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185802",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378552101",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354376",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781516960",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598086360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090115000",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090115001",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65084041442",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041005",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341101",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341105",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354005",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904727061",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668043060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005360",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036360",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041005",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053816",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053882",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353073518",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353073582",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028809",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028810",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028850",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073613",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073686",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073688",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090282000",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090296400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079039101",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079039120",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080560",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150906",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217025230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217025260",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217025290",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746031501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746031560",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187095230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187095260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092604",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092610",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092628",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874092690",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544046451",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544046453",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544046482",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084069701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084069711",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717003",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717006",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717009",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788777603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788777606",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788777609",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781906",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087703",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087707",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087712",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005802",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518264100",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335078301",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335078303",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041552",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341201",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341205",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720081",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720085",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720090",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720091",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720092",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354125",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904658561",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721461",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668043125",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668043160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036430",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036460",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036490",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063074430",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091330",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028910",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028950",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075201",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075205",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073713",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073786",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073788",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086100",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086102",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086103",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086202",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090307800",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090345300",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385402",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385403",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017560",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079039201",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079039220",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080630",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134500",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700002830",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700002860",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700048730",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700048760",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064430",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064460",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700089530",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700089560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864084030",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864084060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746031601",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746031660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021705",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021725",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021760",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760040798",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760083960",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003830",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919092190",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072630",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072690",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629287301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629287302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629287303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739071410",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029953",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029980",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071012230",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071012260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070825",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070895",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680802",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680803",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680806",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680808",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680809",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780702",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780703",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780706",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780708",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780709",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087803",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087807",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087812",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005922",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518307900",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518331800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015196",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015696",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056530",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000602",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000604",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000606",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000607",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013502",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013504",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013507",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335061201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335078501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335078502",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335078503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335170201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189034930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189034960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115544513",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185111160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341301",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378341305",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668043260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018983",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090083",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547029009",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547029010",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073886",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073888",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002153603",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217009030",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217009060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746031760",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429021860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717402",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717403",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717406",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717408",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717409",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087907",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436006001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335080101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610058283",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115681108",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115681110",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378200877",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241532",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241541",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241546",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333105",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333119",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552810",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552831",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708461",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010103",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010150",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044310",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044315",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010102",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010106",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010107",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068007",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068014",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068020",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068021",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068028",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068060",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261068090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356062730",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034805",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034809",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034830",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041409",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137200",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137202",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090290400",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014011",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014013",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079004701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079004720",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034550",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149500",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149503",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149509",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027914",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027960",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027990",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700025430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700068430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071050",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746075830",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746075890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429093305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429093330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429093390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031211",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006960",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919058930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919058960",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067460",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187071390",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187076690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376204",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629376206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032204",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051904",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071202306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031902",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031906",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035305",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693108",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693109",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782006",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782008",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782009",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087502",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087512",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680015792",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003411",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003412",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003413",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001004",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518085900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518205100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518236502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245802",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934072430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934072490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205007690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205029130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205029190",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205039490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096730",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096755",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335104401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034660",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610054360",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013460",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013472",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189025290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378200905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243032",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243041",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243046",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552910",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552931",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657304",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010200",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010203",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010250",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044410",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044415",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044416",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010202",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010206",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010207",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062702",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062707",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062714",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062720",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062721",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062728",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062760",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038890",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014205",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014230",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090105900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090105901",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090272100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090272101",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090524500",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090524501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014111",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014115",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010901",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010903",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020705",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034650",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034690",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150803",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014330",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014360",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014390",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700025730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700025790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700082030",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700082090",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071150",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429035805",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429035830",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429035890",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213801",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331601",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331602",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331603",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331604",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847501",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847601",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032104",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032105",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052004",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052005",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071131100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084025211",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084025221",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032009",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035406",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680901",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680903",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680906",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680908",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712108",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712109",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788722101",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788722103",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788722106",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788722108",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788722109",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734701",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734703",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734706",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734708",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788734709",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786306",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786308",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799203",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799206",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799208",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799209",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827208",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087602",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087612",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680015892",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003511",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003512",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003513",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001102",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001104",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001106",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518122900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518233200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934075890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934080430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096830",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096855",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096890",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335033101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335068701",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082401",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082403",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335111403",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013160",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012472",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789011290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282048130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378043501",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378043505",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720460",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781106401",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781106410",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663661",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019201",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689012001",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001307",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001314",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001321",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001328",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001330",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001340",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001360",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001390",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358036260",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063099430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057553",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057560",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057570",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057580",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057583",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057592",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076770",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076792",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999034960",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999034990",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078500",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078503",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186900",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186903",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014311",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014315",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436910102",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079094401",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079094420",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065500",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065502",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065530",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065540",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065560",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065590",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141700",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141703",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141706",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073330",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289073360",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700077930",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700077960",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864080830",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864080890",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429074701",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505015701",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035101",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035111",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323301",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323302",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323303",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323304",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323305",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629323306",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061601",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061604",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061610",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061612",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061615",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061620",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061625",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061628",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061630",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061640",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061650",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061660",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061670",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061672",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061674",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061677",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061680",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874061690",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980020201",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061430",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061460",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001030900",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731901",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731903",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731906",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731908",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731909",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798803",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798806",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798809",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097091807",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518158400",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518158401",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335018202",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016483",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045730",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007030",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378043301",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378043305",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720330",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720360",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781105301",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781105310",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663561",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019101",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689011901",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073530",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063028430",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063028460",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063028498",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088030",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088060",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057453",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057470",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057488",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999091830",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999091860",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014211",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014215",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079094301",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079094320",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959089860",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144700",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144703",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144706",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864079430",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429074601",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505015801",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034001",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034011",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003760",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739070610",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980020101",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243035106",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544040651",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544040653",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544040670",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544040680",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544040694",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089251",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089253",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089270",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089280",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089294",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001030800",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097091707",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518156600",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293400",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001301",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001302",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079101",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037253",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037270",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037280",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037294",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005401",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005405",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169101",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169102",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169103",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378115001",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378115005",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904712161",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017630",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017690",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020201",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020216",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002401",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002405",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689090701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689090705",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024501",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024505",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001430",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001490",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005510",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005560",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008401",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008405",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066301",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066305",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063078590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999081200",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999081230",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999081260",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090277300",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316800",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090534701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098601",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098620",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020201",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020205",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041505",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067660",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067690",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052630",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052690",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053030",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053090",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864078230",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039105",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029201",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029205",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060030",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060060",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060090",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090430",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090490",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057110",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057115",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057120",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057128",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057130",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057160",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057190",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074206",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074208",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243024409",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243035909",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052820",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052845",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052890",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073753",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073770",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073780",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073792",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018101",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018105",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701703",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701706",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701709",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788503",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788506",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788509",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808601",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808603",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808606",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808609",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892903",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892906",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892909",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111701",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111705",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009210",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009250",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203100",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518327900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934018490",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000702",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020853",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020880",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025753",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025780",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028153",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028160",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028180",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030253",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030270",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030280",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030292",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059653",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059660",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059670",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059680",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059692",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189017530",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189017590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189020082",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044890",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018190",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006401",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006405",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026801",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026805",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093100301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093100305",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169213",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169219",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116505",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116580",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116591",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720830",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720890",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689961",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020312",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002508",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092105",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092106",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024616",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024618",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001500",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001530",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001590",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005630",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066401",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066405",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060730",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060760",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060780",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211101",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211103",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090465701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090465703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013511",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013515",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079096001",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079096020",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020305",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071300",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071330",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071345",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071360",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071390",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700010060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700043360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700080360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700086190",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700086960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700086990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864096315",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039205",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029305",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760054860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057930",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057972",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040290",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629174701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629174702",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629174703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629174704",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095401",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095410",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095415",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095420",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095430",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874095460",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087530",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018201",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018205",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788746206",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788746209",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787509",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796809",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976606",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976609",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111805",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009310",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009350",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518038000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518040100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518105001",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205028030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205028090",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027205",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027206",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335098503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335160503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335175204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018353",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020630",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029160",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029930",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029953",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029980",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029992",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034453",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064080",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064092",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023530",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023590",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026901",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026905",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030302",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093520005",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093520006",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378117591",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028912",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155009705",
      "ndc_label_name": "BusPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155009706",
      "ndc_label_name": "BusPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689093306",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024705",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024716",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005730",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291017750",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074403",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008605",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008660",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066560",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079099401",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079099420",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083460",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039360",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241401",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241501",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629333301",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629333302",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874088730",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874088760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074403",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018305",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018314",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004301",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004302",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111906",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009406",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009450",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198100",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198101",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198102",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198103",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230000",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518259100",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280300",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306500",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338200",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338201",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099101",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099102",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099103",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099106",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174905",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014260",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006605",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006660",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027060",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169001",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169002",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169003",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904712261",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020016",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002301",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002305",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005430",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358005490",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060953",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060980",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098501",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098520",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065430",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217027660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700000130",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700093730",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038905",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429029105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919096590",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629240801",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629240901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629319701",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629319702",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629319703",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629319704",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068801",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068810",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068820",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068828",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068830",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068860",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874068890",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074106",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074108",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788687801",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788687803",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788687806",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788687809",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698401",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698403",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698406",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698409",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795206",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795209",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004001",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004002",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111501",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111505",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009110",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009150",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518140400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518192401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518272400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049390",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016553",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016560",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016580",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020353",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020360",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020380",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026653",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026680",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030792",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060453",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060460",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060480",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060492",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026601",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026605",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033402",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033403",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114501",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020101",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078501",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291017690",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543078706",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008301",
      "ndc_label_name": "BusPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008305",
      "ndc_label_name": "BusPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884072501",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884072505",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561400",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037801",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041401",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088130",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039001",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380078706",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380078707",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382062301",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757101",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757103",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757106",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757109",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111601",
      "ndc_label_name": "BusPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283000",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283001",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316500",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034260",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610036060",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610040460",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610048760",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060860",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045830",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006301",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006305",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026701",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672210002",
      "ndc_label_name": "Butenafine HCl CREAM 1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00409162301",
      "ndc_label_name": "Butorphanol Tartrate SOLUTION 1 MG/ML Injection",
      "drug_tier": "Brand",
      "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": "Brand",
      "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": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162609",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162610",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Brand",
      "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": "Brand",
      "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": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108901",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310654001",
      "ndc_label_name": "Bydureon BCise Auto-injector 2 MG/0.85ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310654004",
      "ndc_label_name": "Bydureon BCise Auto-injector 2 MG/0.85ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310652401",
      "ndc_label_name": "Byetta 10 MCG Pen Solution Pen-injector 10 MCG/0.04ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310651201",
      "ndc_label_name": "Byetta 5 MCG Pen Solution Pen-injector 5 MCG/0.02ML Subcutaneous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093542088",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155082373",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884067314",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315700",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583400",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742011808",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762100501",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002426",
      "ndc_label_name": "Cabometyx Tablet 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002526",
      "ndc_label_name": "Cabometyx Tablet 40 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002326",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51552020005",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53191012401",
      "ndc_label_name": "Cal-Citrate CAPSULE 150 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487003511",
      "ndc_label_name": "Cal-Citrate Plus Vitamin D Tablet 250-2.5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "27434001015",
      "ndc_label_name": "Cal-Quick Liquid 500-10 MG-MCG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51407060612",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060660",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415403",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415404",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087861",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087878",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031065",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031066",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115147555",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168040060",
      "ndc_label_name": "Calcipotriene SOLUTION 0.005 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713031853",
      "ndc_label_name": "Calcipotriene SOLUTION 0.005 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383073202",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781632079",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884016111",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505082306",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629215201",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904506260",
      "ndc_label_name": "Calcitrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672527803",
      "ndc_label_name": "Calcitrene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672527804",
      "ndc_label_name": "Calcitrene Ointment 0.005 % External",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054000713",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054000725",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093735201",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155011801",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155011803",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066201",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066203",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003409",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003430",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003481",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063309",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063330",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063381",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353099809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016901",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016930",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034511",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096783",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096788",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304023901",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304023930",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629244501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874101",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072304",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072306",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020713",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020720",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052109",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005801",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093735301",
      "ndc_label_name": "Calcitriol CAPSULE 0.5 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155011901",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066301",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017001",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096888",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304024001",
      "ndc_label_name": "Calcitriol CAPSULE 0.5 MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874201",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072406",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020820",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054312041",
      "ndc_label_name": "Calcitriol SOLUTION 1 MCG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304024159",
      "ndc_label_name": "Calcitriol SOLUTION 1 MCG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044715",
      "ndc_label_name": "Calcitriol Solution 1 MCG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40985027070",
      "ndc_label_name": "Calcium 1000 + D Tablet 1000-20 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917008595",
      "ndc_label_name": "Calcium 1200 Tablet Chewable 1200-1000 MG-UNIT Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011333",
      "ndc_label_name": "Calcium 600 +D High Potency Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007541",
      "ndc_label_name": "Calcium 600+D Plus Minerals TABLET 600-400 MG-UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007002",
      "ndc_label_name": "Calcium 600+D Plus Minerals TABLET CHEWABLE 600-400 MG-UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074706",
      "ndc_label_name": "Calcium 600+D Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012500",
      "ndc_label_name": "Calcium 600+D3 Plus Minerals TABLET CHEWABLE 600-800 MG-UNIT Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027531",
      "ndc_label_name": "Calcium 600+D3 Tablet 600-20 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845014031",
      "ndc_label_name": "Calcium 600/Vitamin D Tablet Chewable 600-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054008813",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054008826",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781208102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904654606",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904654661",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666825",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711906",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711961",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135062902",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571081320",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856008802",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155053102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689079302",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033002602",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018920",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49230064441",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014811",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014815",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293082502",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429049102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135019122",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162059020",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084047901",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084047911",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000259",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000261",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004459",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004461",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180013415",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086283",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518237200",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518272300",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282037702",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135019222",
      "ndc_label_name": "Calcium Acetate Tablet 667 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536122922",
      "ndc_label_name": "Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002834",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Capsule 200-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440722792",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103040299",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681013800",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681013700",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054311763",
      "ndc_label_name": "Calcium Carbonate Antacid SUSPENSION 1250 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536120610",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001033",
      "ndc_label_name": "Calcium Carbonate POWDER 800 MG/2GM ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055581",
      "ndc_label_name": "Calcium Carbonate TABLET 1250 (500 Ca) MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904323261",
      "ndc_label_name": "Calcium Carbonate Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017082",
      "ndc_label_name": "Calcium Carbonate TABLET 600 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268014911",
      "ndc_label_name": "Calcium Carbonate Tablet Chewable 1250 (500 Ca) MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002721",
      "ndc_label_name": "Calcium Carbonate TABLET CHEWABLE 260 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055585",
      "ndc_label_name": "Calcium Carbonate-Vitamin D Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011329",
      "ndc_label_name": "Calcium Citrate + D Tablet 250-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268014715",
      "ndc_label_name": "Calcium Citrate + D3 Maximum Tablet 315-6.25 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487003383",
      "ndc_label_name": "Calcium Citrate GRANULES 760 MG/3.5GM ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54022108402",
      "ndc_label_name": "Calcium Citrate Tablet 1040 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002842",
      "ndc_label_name": "Calcium Citrate TABLET 250 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027709",
      "ndc_label_name": "Calcium Citrate+D3 Petites Tablet 200-6.25 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629168601",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 200-3.125 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610015832",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629788216",
      "ndc_label_name": "Calcium Citrate-Vitamin D3 Liquid 1000-0.01 MG/30ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014165",
      "ndc_label_name": "Calcium Gummies TABLET CHEWABLE 250-100-500 MG-UNIT Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103036907",
      "ndc_label_name": "Calcium High Potency/Vitamin D Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002321",
      "ndc_label_name": "Calcium Lactate TABLET 100 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536342201",
      "ndc_label_name": "Calcium Lactate Tablet 648 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292032119",
      "ndc_label_name": "Calcium Lactate TABLET 750 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010067",
      "ndc_label_name": "Calcium Plus D3 Absorbable Capsule 600-62.5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312006272",
      "ndc_label_name": "Calcium Plus Vitamin D Capsule 500-1.25 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070045",
      "ndc_label_name": "Calcium Tablet Chewable 500-2.5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681008900",
      "ndc_label_name": "Calcium Tablet Chewable 500-2.5 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002508",
      "ndc_label_name": "Calcium-Vitamin D3 Capsule 600-10 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904188260",
      "ndc_label_name": "Calcium-Vitamin D3 Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00310051260",
      "ndc_label_name": "Calquence Capsule 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310351260",
      "ndc_label_name": "Calquence Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00005556819",
      "ndc_label_name": "Caltrate 600+D3 Soft Tablet Chewable 600-20 MG-MCG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00005551210",
      "ndc_label_name": "Caltrate Minis Plus Minerals TABLET 300-800 MG-UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51862010201",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862010206",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862088401",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862088403",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093614882",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093614891",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093313482",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093313491",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378323177",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378323193",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593831",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593892",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011607",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011610",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884066009",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024125",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024195",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034330",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034390",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518271900",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378323277",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378323293",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593931",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593992",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904703404",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011707",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011710",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884066109",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687013025",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687013095",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332006030",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332006090",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378322477",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378322493",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593631",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011407",
      "ndc_label_name": "Candesartan Cilexetil TABLET 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011410",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884065809",
      "ndc_label_name": "Candesartan Cilexetil TABLET 4 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034130",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034190",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212601",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378322577",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378322593",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781593731",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011507",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011510",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884065909",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011925",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011995",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034230",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034290",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212701",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518288400",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300105",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300177",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013110",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013115",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547045909",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559066090",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300205",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300277",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013210",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013215",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547046009",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559066190",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518272000",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300305",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300377",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013310",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013315",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547046109",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559066290",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29978042016",
      "ndc_label_name": "CapCof SYRUP 5-2-10 MG/5ML ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72060011040",
      "ndc_label_name": "Caplyta Capsule 10.5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72060012140",
      "ndc_label_name": "Caplyta Capsule 21 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72060014230",
      "ndc_label_name": "Caplyta Capsule 42 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72060014240",
      "ndc_label_name": "Caplyta Capsule 42 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29978060190",
      "ndc_label_name": "Capmist DM TABLET 60-15-400 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00310782030",
      "ndc_label_name": "Caprelsa Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468782003",
      "ndc_label_name": "Caprelsa Tablet 100 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310784030",
      "ndc_label_name": "Caprelsa Tablet 300 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468784003",
      "ndc_label_name": "Caprelsa Tablet 300 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29978012716",
      "ndc_label_name": "Capron DM Liquid 7.5-7.5 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29978012810",
      "ndc_label_name": "Capron DMT TABLET 30-30 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536252525",
      "ndc_label_name": "Capsaicin CREAM 0.025 % EXTERNAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126456",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000055601",
      "ndc_label_name": "Capsaicin Heat Patch Patch 0.025 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00143117401",
      "ndc_label_name": "Captopril TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378302201",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808001",
      "ndc_label_name": "Captopril TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014401",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053630",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053660",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629873001",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034901",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034910",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034930",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052801",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052850",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117101",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117110",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300701",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300710",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723060",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723090",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723092",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723094",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781805201",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781805210",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904504561",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710561",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016010",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014101",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063014630",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079086301",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079086320",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217000300",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217000330",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217000360",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217000390",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030411",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030421",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872701",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544015045",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544015060",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544015073",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544015092",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052201",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052210",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330700",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117201",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117210",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378301201",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378301210",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723130",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723160",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723190",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723191",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723192",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723194",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781806101",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781806110",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904504661",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710661",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014201",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097400",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097430",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097460",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097490",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010500",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010510",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010530",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010560",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090184003",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090429603",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079086401",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079086420",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043100",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043130",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043160",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289034430",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289034490",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864006628",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031511",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031521",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133801",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133802",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133803",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872801",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034701",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034702",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034705",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034720",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034730",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034740",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034742",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034745",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034790",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052401",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052410",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117301",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117310",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378301701",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378301710",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723230",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723260",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723290",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723291",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723292",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723294",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781807501",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781807510",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904504761",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014301",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018200",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018230",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018260",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261018290",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999051130",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999051160",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108600",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108603",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108606",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289021230",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289021290",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254101",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254102",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254103",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254104",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872901",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034801",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034810",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034814",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034820",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034830",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034860",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874034890",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052601",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052610",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008101",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082709",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008301",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082809",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008401",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082909",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008601",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571083009",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856017030",
      "ndc_label_name": "Carafate Suspension 1 GM/10ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58914017014",
      "ndc_label_name": "Carafate Suspension 1 GM/10ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033001912",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017011",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017013",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415101",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280507",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040732",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904688504",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033002012",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017111",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017113",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415001",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280607",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872101",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040832",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317600",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317601",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033000412",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017211",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017213",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672414901",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280707",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872001",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040932",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781801601",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602211",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068001",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746078901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176900",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176902",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317400",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007212",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781598701",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068101",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746079001",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687058311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687058321",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084056111",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084056121",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055601",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018100",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018102",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518265300",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007312",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781598801",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068201",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746079101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059421",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084056211",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084056221",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055701",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518154500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007412",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121086205",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121086230",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121094705",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121094794",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121172410",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121172430",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189410",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189494",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404709",
      "ndc_label_name": "CarBAMazepine SUSPENSION 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432012916",
      "ndc_label_name": "CarBAMazepine SUSPENSION 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000759",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000762",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000859",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000862",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954024010",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093010901",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093010910",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723620",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723628",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723690",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723691",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617250",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617261",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026801",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026805",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026810",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067602",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067607",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067614",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067620",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067621",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067628",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067630",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261067690",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063032812",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063032830",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095330",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095353",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095360",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095380",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061600",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061601",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061660",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061690",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090038400",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090038403",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216100",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216101",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216103",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090269700",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090444300",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574000",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574003",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079038501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079038520",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407021501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407021510",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400501",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400502",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400503",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289021030",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864084330",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429003201",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429003210",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505018300",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505018301",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629871501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629875301",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049202",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049204",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049210",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049220",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049230",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049240",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049245",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049260",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049290",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267027890",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267027891",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544058332",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544058353",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544058360",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544058380",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084044401",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084044411",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721001",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721002",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721003",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721006",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721008",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721009",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782503",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782506",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782509",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518090200",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224202",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224203",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224204",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224205",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224206",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224207",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224208",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248900",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248901",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248902",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248903",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248904",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248905",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248906",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284102",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284103",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518314600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518314601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002590",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069101",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033630",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033653",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033680",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189015730",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834022100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834022101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093077801",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723528",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723590",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723591",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904385461",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904385480",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668027101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668027105",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999078201",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079087001",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079087020",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404102",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429093405",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047901",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047911",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143300",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242600",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242601",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242602",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006701",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012301",
      "ndc_label_name": "Carbidopa TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386098001",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975022010",
      "ndc_label_name": "Carbidopa TABLET 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781033201",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407015801",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407031401",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651014601",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629193201",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919301",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682020025",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007817",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032709",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046001",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046010",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079097801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079097820",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756046188",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001017100",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028111",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378009401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007901",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007917",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046110",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092320",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756045788",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067251",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067260",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067280",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001017200",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028201",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028211",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253850",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378007801",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261071930",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261071990",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356062860",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046550",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999099860",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085505",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039050",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051713",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051788",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739010710",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087711",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087730",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087755",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087764",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087772",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087778",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087790",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010600",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253950",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253996",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008501",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904623761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904725761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261072030",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261072090",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020260",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020280",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353051060",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353051080",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075601",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075620",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079088401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079088420",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039100",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039110",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687066101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687066111",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051813",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051818",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051888",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739001710",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739010810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009311",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325000",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087811",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087830",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087855",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087864",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087872",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087878",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087890",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064780",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254010",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254050",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254096",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378113301",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904623861",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356062960",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046710",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999099960",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862008001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862008005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862008010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039200",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039250",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064230",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429015405",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051913",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051988",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756098501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756098502",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629915401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739001310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009401",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009411",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367034001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367034005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087911",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087930",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087955",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087964",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087972",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087978",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087990",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378505101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018688",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 10-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378505201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018788",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378505301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018888",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830001",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781561301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000188",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078204",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781562501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069001",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000288",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078304",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781563701",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000388",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078404",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781564101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000488",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078504",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781565401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000588",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078604",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781566901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000688",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078704",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424601",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424681",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029533",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781060427",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044615",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55390022101",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703015005",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033922",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017215",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010015",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424801",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424881",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424891",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029534",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020245",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781060594",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044745",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033501",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55390022201",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703026205",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033950",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017245",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010045",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424401",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424481",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029531",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781060320",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044505",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033918",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703036018",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017205",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010005",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703423901",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703423981",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029512",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020251",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335028440",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781060694",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044860",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038601",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033956",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703060005",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017260",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758004704",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010051",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006815",
      "ndc_label_name": "Carboxymethylcellulose Sodium Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35573045960",
      "ndc_label_name": "Carglumic Acid Tablet Soluble 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011460",
      "ndc_label_name": "Carglumic Acid Tablet Soluble 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023805",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023810",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023815",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305100",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305101",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059705",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059790",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629823201",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335122301",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312400",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059805",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059890",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059905",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059990",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037060005",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037060090",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363301",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363305",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522301",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630261",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019030",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019081",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019090",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014401",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014405",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097530",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097560",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261097590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090860",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012593",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016030",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016053",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016060",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016070",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016080",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087430",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087480",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025610",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025650",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255500",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255501",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255502",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255503",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255504",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093101",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093120",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004105",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002801",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002805",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024513",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024518",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024588",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760014460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919072830",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919072890",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187044730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187044790",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366901",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366902",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366903",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015100",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015103",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645035159",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753901",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753903",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753906",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753909",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815103",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815106",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815109",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788973803",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051530",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934070730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934070790",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036802",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036804",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036806",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006660",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006680",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189037230",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003605",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011201",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011250",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729601",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729605",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363401",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363405",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522401",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630361",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063701",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063705",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019130",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019190",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014501",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014505",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053700",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053730",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053760",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053790",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261053799",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052600",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052630",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052660",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052690",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012930",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012960",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012993",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013353",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013360",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013380",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083209",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083260",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083280",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025710",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025750",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093201",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093220",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004205",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002905",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154567600",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024713",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024718",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024788",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760014560",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023560",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053390",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073030",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073060",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073090",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040930",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040960",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015200",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015203",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071085630",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645049659",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681906",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681908",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681909",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791001",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791003",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791006",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791009",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823101",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823109",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182601",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182602",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518238900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934040630",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934065330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934075990",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027303",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027304",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006760",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006780",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003700",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003701",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003705",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011301",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011350",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005105",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363105",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630061",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063301",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063305",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014205",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098630",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098660",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098690",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012660",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012693",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083753",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083760",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083780",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025410",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025450",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206602",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079077101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079077120",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003901",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003905",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002605",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024213",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024218",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024288",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919021930",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919021990",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094160",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015300",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015303",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745801",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745803",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745806",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745808",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745809",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825203",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825206",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825208",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825209",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788969103",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518058201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137700",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137701",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137702",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137703",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137704",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003400",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003401",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003405",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011001",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011050",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093013501",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093013505",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363201",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363205",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522201",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630161",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063405",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544018790",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107014305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084800",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084830",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084860",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084890",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261084899",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356051218",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356051230",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356051260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356051290",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063083360",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015653",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015680",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083830",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083853",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083860",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083880",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025510",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547025550",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106401",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217503",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217504",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093001",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093020",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004005",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002701",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343002705",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081918",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081990",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024413",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024418",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024488",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760014360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023360",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760037660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760053260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760058260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919098430",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919098460",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919098490",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094690",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366801",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366802",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366803",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015400",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015403",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071084130",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085411",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645035059",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681701",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681708",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788978903",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042600",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042601",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042603",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042604",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051760",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934068660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056101",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056102",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056104",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006330",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006353",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006380",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003505",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011101",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011150",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342101",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342194",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781061307",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035601",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035610",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457083150",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010610",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010601",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611070001",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342301",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342394",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781061407",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035801",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035810",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457083270",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010710",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010701",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611070201",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452183003",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000002401",
      "ndc_label_name": "Castor Oil Oil 100 % Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61958090101",
      "ndc_label_name": "Cayston Solution Reconstituted 75 MG Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998501",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006520",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006530",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036700",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036714",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036715",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036720",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036721",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036730",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036740",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021130",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442017130",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011901",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011912",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011915",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011918",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011920",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011921",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011924",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011928",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011930",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998601",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006620",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006630",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063019430",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051802",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090160200",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090160202",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036810",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036814",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036820",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036821",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036828",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036830",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036840",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442017230",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012001",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012010",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012012",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012015",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012018",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012020",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012021",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012024",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874012030",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093108701",
      "ndc_label_name": "Cefaclor ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594012501",
      "ndc_label_name": "Cefaclor SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594025001",
      "ndc_label_name": "Cefaclor Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81948625001",
      "ndc_label_name": "Cefaclor Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594037501",
      "ndc_label_name": "Cefaclor SUSPENSION RECONSTITUTED 375 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093319601",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093319653",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143994701",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143994720",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143994750",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724202",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724206",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724210",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544013520",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038801",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038802",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001814",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261001820",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006714",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006728",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055310",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055314",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055320",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055328",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063059520",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063059528",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999002110",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999002114",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999002120",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090058000",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090058002",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191500",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191502",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605000",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605002",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635600",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635602",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042804",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042810",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042814",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042815",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042816",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042818",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042820",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042828",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042830",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002022914",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002022920",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289058910",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289058914",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289058920",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289058928",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009601",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009650",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422301",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422401",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422501",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629798801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629825301",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053301",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053304",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053310",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053312",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053314",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053315",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053320",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053325",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053328",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053330",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053340",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053344",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053360",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053372",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053374",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053377",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874053390",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008501",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008550",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004510",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004514",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004520",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004524",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004528",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004530",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018001",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018008",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641601",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641602",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641603",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641604",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641606",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748401",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748402",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748403",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748404",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748406",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826102",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826103",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253800",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005691",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005694",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008191",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008194",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189010306",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189010320",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044506",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044520",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019802",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143976701",
      "ndc_label_name": "Cefadroxil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143976750",
      "ndc_label_name": "Cefadroxil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038901",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009701",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008301",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018102",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143976601",
      "ndc_label_name": "Cefadroxil Suspension Reconstituted 500 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143976675",
      "ndc_label_name": "Cefadroxil Suspension Reconstituted 500 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039001",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039002",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009801",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009875",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008401",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008475",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018202",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018203",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926201",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926225",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992490",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409080501",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409080511",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345170",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345196",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010110",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010167",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567012025",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070725",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271400",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505074901",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505074904",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505074905",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614200",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614205",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624300",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624304",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023710",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330001525",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518304700",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518304701",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067901",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005501",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005525",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409258501",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409258511",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926101",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926110",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998303",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998391",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409080601",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409080611",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345246",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345295",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010269",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010299",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070810",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076900",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076901",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505609401",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614300",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614304",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624400",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624404",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023861",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005601",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005610",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623100",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623105",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913901",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913925",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914001",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914025",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992390",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345070",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345095",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010010",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010066",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070625",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023610",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330001425",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338350341",
      "ndc_label_name": "CeFAZolin Sodium-Dextrose Solution 1-4 GM/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338350841",
      "ndc_label_name": "CeFAZolin Sodium-Dextrose SOLUTION 2-4 GM/100ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093316006",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781217660",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039101",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039102",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356003820",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043025006",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063046614",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063046620",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063085220",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063085320",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103200",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103300",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103301",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103303",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090263600",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271901",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271903",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604100",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959013420",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003010",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003020",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003030",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003060",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700017120",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700021420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052520",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700076420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009960",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687069911",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687069921",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084014",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084020",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367101",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367102",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367103",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367104",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367105",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017760",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054360",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001036206",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180071160",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788711102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737502",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760602",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798702",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840402",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976002",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68820006306",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253700",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004420",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006220",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934016420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057614",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057620",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030814",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030820",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042320",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006120",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413664",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413673",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607746",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607761",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039201",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039202",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261092601",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356011960",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043025138",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043025167",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090425800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007101",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217029801",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187083500",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021801",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021860",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054788",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054798",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072204",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072205",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072210",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072220",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004232",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018532",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413764",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413773",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607846",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607861",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039301",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039302",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261090501",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356019000",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043025238",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043025267",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090558300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187061600",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021901",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021960",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054888",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054898",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072304",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072305",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072310",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072320",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788684001",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706201",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725501",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784401",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038000",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038060",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040560",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004332",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018632",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189025932",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409956601",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409956610",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322280",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322295",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012120",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012166",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567013010",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024010",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505603001",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505603004",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614400",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614404",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614600",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614604",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624500",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624504",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032620",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032621",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020902",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020941",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008901",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008902",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000815",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409973501",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409973510",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322391",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322395",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012250",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012267",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567013110",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024110",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614500",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614504",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614700",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614704",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624600",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624604",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034020",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034021",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021002",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021041",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009001",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009002",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000920",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877058433",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877058450",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180041608",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180041611",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042308",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042311",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274900",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274901",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274902",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274904",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322100",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322101",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322102",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322103",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322104",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076601",
      "ndc_label_name": "Cefixime Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067350",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075150",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040501",
      "ndc_label_name": "Cefixime Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076701",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076702",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067450",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067451",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075250",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075275",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040703",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040704",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987801",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987825",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010910",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024525",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024585",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075901",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075905",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034101",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034125",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034129",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987610",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011199",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024710",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076101",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076104",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034366",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987701",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987725",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011020",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024625",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024685",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076001",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505076005",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034201",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034225",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034229",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781616946",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781616952",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040301",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040302",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040310",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040350",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014101",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014150",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040201",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 50 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040202",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 50 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014001",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 50 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014050",
      "ndc_label_name": "Cefpodoxime Proxetil SUSPENSION RECONSTITUTED 50 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543820",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039401",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043012020",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008320",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959079610",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009501",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009520",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877055920",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877087820",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292051001",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543901",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543920",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039501",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358006820",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043012120",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008420",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289039302",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009601",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009620",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877056020",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877087920",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620246",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620257",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620291",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039601",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039602",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039603",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026238",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026257",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026277",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003401",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003450",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003475",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096003",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009901",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009975",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040101",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040102",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040103",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620346",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620357",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781620391",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039701",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039702",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039703",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026338",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026357",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043026377",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322600",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003501",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003550",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003575",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096101",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010075",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040201",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040202",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040203",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093107701",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724703",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724720",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781504301",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003601",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040301",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093107853",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724620",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781504401",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781504450",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063084220",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090171000",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090173900",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959030020",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003120",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217003130",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029420",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045520",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700070820",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003750",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014950",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006950",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040401",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264314311",
      "ndc_label_name": "cefTAZidime and Dextrose Solution Reconstituted 1-5 GM-%(50ML) Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264314511",
      "ndc_label_name": "cefTAZidime and Dextrose Solution Reconstituted 2-5 GM-%(50ML) Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781317780",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781317796",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012720",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012766",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023525",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012850",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012867",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023610",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781317946",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781317986",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012969",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012999",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 6 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023706",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 6 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985701",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985725",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733211",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733220",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733221",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320885",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320895",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781932885",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781932895",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010610",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010667",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070125",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070195",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094500",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094501",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271200",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090381000",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090381001",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217006201",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614800",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614804",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034610",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679098301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679098302",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021302",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021342",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063301",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063310",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000310",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518016800",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249900",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249901",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309900",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309901",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335500",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335501",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009602",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205054501",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006101",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006125",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733304",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733311",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733331",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733349",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000501",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143967801",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733410",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733420",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781321046",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010869",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010899",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505067905",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615005",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034861",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021515",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009801",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985601",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985625",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733503",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733513",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733520",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733521",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320990",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320995",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010720",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010768",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070225",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070295",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614900",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614904",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034720",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070302",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021402",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021442",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180064401",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180064410",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000401",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000410",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009702",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006201",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006225",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733604",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733611",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000601",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985901",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985925",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733701",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733711",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733720",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733721",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320685",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320695",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090187500",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090244400",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217011701",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075001",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075004",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615101",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615104",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070101",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070102",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070103",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021102",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021142",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180061101",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180061110",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000101",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000110",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009402",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205011701",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985801",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985825",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733801",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733811",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733820",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733821",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320785",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320795",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010510",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010566",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070025",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094400",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090262800",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090344700",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090383800",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075100",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075101",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505075104",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615204",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070202",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021202",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021242",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180062201",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180062210",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000210",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230100",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230101",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009502",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724503",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724504",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040001",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040002",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043820",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043830",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261043860",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058420",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063065720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999030920",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999030930",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215800",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215803",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215900",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343006220",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343006260",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289038504",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289038530",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005820",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005860",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065620",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065660",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027211",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027294",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004420",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919014520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187099120",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944601",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944701",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092101",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092102",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862069920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862069960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021560",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030220",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030260",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040101",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040102",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061530",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061560",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999078520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215700",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033420",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033460",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343006320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52343006360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093930",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700043620",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028311",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028394",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629356201",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629356202",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944801",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092201",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092202",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070020",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070060",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021620",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021660",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030320",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030360",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788991402",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788991403",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788991406",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518269400",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518321500",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008820",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003514",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003560",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956701",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956725",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997722",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997790",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011920",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956801",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956825",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997922",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997990",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011810",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093716501",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716505",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398301",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398305",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650261",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044101",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044105",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811065910",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073201",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073202",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015611",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015615",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638000",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016811",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016815",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398301",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436790101",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079019901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079019920",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217015630",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217015660",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151601",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151603",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384805",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043611",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004530",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004560",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068260",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014131",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014171",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030160",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187033160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187064360",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550401",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550402",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550403",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550404",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096911",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039601",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039602",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694106",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694109",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892403",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892406",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892409",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042207",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042212",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018381",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518274800",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292200",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002060",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029203",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093604",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093605",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180401",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180403",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180405",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201903",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030205",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030230",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012372",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002310",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024307",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014202",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016702",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032302",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032303",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002120",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002130",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716601",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716605",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715005",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398405",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650361",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544095314",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044201",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044205",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811066010",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811066050",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073301",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073302",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015711",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015715",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358090215",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358090230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066010",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066910",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066914",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066920",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066930",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066960",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082510",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082514",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082530",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082560",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003630",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025753",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242700",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318300",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478900",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016911",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016915",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436384901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436384902",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436770101",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436770102",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021520",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217015730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217015760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020630",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217020660",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217031130",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217031160",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217031190",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700033730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700033760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700043014",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700043030",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700043060",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700045014",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700045030",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700045060",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151701",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151703",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046105",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384905",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044711",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020815",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020830",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020860",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074215",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082415",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084915",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016830",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016860",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036010",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036015",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036030",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036060",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083710",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083742",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014231",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014271",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014291",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056230",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056260",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063330",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063360",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550301",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550302",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550303",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550304",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084097601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084097611",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639306",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639308",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639309",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646306",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646308",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646309",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713403",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713406",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713408",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713409",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726403",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726406",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726409",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773503",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773506",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773508",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773509",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819703",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819706",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819708",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819709",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788893603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788893606",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788893609",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896906",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896909",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788927303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788927306",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788927309",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042107",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042112",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002203",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018481",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399019485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015415",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015430",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015460",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015490",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680013500",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134600",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518320400",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329200",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002614",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005530",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005560",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106606",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028353",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058453",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030305",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036010",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036030",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036060",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036090",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025914",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000907",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004002",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020904",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028102",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028103",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028104",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002220",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093717006",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378717091",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398560",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031001",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031005",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031060",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811066160",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073401",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015809",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151802",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046260",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014360",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862091060",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039807",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042003",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002301",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002302",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002303",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018581",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002503",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093730606",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716591",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398260",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668030760",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811065860",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073101",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015509",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072060",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151501",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045960",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384706",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014060",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090760",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039507",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042303",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002001",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018281",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030101",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030130",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030160",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002203",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071052524",
      "ndc_label_name": "Celontin Capsule 300 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093314501",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093314505",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440124340",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724328",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724340",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002130",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544014230",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544086830",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544086840",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094608",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094621",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094628",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094630",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094640",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634043371",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007115",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007120",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007128",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007140",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007160",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014001",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014005",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291020850",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021110",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021118",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049704",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049706",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049708",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049709",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049710",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049715",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049720",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049728",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049730",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049740",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004104",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004110",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004112",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004120",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004128",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999004130",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007002",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007100",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007202",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007203",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007204",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007205",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007208",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320202",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320203",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320204",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320205",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320208",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329100",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015111",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015115",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003001",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003008",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003012",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003020",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003024",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003028",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003030",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003040",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003056",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217029940",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348056028",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005706",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005710",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005715",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005720",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005724",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005728",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005730",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005740",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014540",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700062028",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700062030",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700062040",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007230",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007240",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687015201",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687015211",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442016101",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442016105",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005030",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135071074",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584023501",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756029313",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756029388",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422201",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629425701",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426701",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426801",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885401",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885501",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898001",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919801",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919901",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011101",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011104",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011112",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011114",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011115",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011116",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011120",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011121",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011124",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011128",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011130",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011140",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011150",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011156",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011160",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011172",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011174",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011177",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011180",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205010114",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001801",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001805",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001840",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004912",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004920",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004928",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004930",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004940",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267076904",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877022001",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877022005",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012101",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012102",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899402",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899403",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899404",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899406",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899407",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899408",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971302",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971303",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971304",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971306",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971307",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788971308",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518227300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518227301",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003730",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003794",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008230",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008294",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934010840",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934084020",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025201",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003440",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093314701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093314705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143989701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143989705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440124440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544000414",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544000420",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544000428",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544000430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544001328",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544001340",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002010",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002510",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002514",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002528",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002530",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544002540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005714",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005720",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005721",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005728",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005730",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005740",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544005760",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008210",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008221",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008230",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544008240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544050314",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544050320",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544050330",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544050340",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544052940",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061714",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061720",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061728",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061730",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544061740",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094510",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094512",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094514",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094520",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094521",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094528",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094530",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094560",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634043440",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634043471",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634043480",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002007",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002008",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002010",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002014",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002020",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002021",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002028",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002030",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002040",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002042",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002048",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002060",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002090",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007215",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007221",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007230",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358007260",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097810",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097820",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097828",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097830",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097840",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097865",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356097875",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014105",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291020950",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021210",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021218",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053604",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053606",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053608",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053609",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053610",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053614",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053620",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053621",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053628",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053630",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053640",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053656",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000700",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000710",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000712",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000715",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000721",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000760",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999000790",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090007906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090008100",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090267700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090274900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090274901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305702",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305706",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305707",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305708",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090311101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319902",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319903",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319905",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319907",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319908",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090342701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090342703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015211",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015215",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011701",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011702",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011703",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011704",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011705",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436011708",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436102001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436102002",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436102004",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436102005",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436221001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436221002",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436221004",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436221005",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655072051",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003100",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003102",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003104",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003106",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003108",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003110",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003112",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003114",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003115",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003120",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003121",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003124",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003128",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003130",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003140",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003156",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959003160",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021810",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021814",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021820",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021821",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021830",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021840",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020710",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020720",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020730",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217020740",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055514",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055520",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055528",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005804",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005808",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005814",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005820",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005821",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005824",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005830",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005840",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289005856",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700000920",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700004314",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700004320",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700004328",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700004340",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700036420",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700036430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700036440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053310",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053314",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053320",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053328",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053330",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053340",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118029402",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118029403",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118029404",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118029407",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007320",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007328",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007330",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007340",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864007356",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687016301",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687016311",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442016201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442016205",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002910",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002920",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002928",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002930",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002940",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003510",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003514",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003520",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003528",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003530",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003540",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005120",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005130",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919035828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919041010",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919041030",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052210",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052220",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052228",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052230",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052240",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060610",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060630",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060640",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060656",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135071174",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62250080208",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584023601",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756029413",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756029488",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004606",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004615",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004630",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004640",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187045428",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187045430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187045440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187059206",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187059220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187059228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187059230",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187059240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422101",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629423001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629425901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629427001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629760501",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629761801",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629774001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629774201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629774301",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011203",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011204",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011205",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011206",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011208",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011210",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011212",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011215",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011216",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011218",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011221",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011224",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011225",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011230",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011250",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011256",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011260",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011272",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011274",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874011277",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205010214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205010240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001905",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001940",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005005",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005006",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005010",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005012",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005014",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005015",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005020",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005028",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005030",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005040",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267005060",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267055928",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267077004",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267077006",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021905",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021984",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071202408",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071435502",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071435507",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012201",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012202",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776102",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776103",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776104",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776105",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776107",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776108",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788932602",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788932603",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788932604",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788932607",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788932608",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788975202",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788975203",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788975204",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788975207",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788995002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788995003",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788995004",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788995007",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305902",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305903",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305904",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305905",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305907",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305908",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305909",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306600",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306602",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518336200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518337800",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003414",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003420",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003421",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003428",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003494",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004010",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004020",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004021",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004030",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004040",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004056",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004094",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006520",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006530",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006594",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934010910",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934010928",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067215",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025182",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000401",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000402",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000501",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000502",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425000602",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425012101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425012102",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425012103",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425012104",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425012105",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417573",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417574",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015414",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015438",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261074401",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014238",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999071300",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020001",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020002",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442020101",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442020102",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048042",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048049",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920401",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920501",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054468",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054488",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012301",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012302",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044001",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044002",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788739101",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788739102",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779602",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417773",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417774",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015514",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015538",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048501",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261048901",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014338",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043014358",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999026120",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090021900",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090022000",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644500",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959062000",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959062001",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014900",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700056300",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065600",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084100",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118997302",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442020201",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442020202",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004932",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079832",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048142",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048149",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885701",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885801",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920701",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267098120",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267098200",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054568",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054588",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180012401",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044101",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044102",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788727101",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788727102",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793801",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793802",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788898601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788898602",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055300",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468022001",
      "ndc_label_name": "Cerdelga CAPSULE 84 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468022002",
      "ndc_label_name": "Cerdelga Capsule 84 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468466301",
      "ndc_label_name": "Cerezyme SOLUTION RECONSTITUTED 400 UNIT Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904264113",
      "ndc_label_name": "CertaVite/Antioxidants TABLET ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904676520",
      "ndc_label_name": "Cetirizine HCl Allergy Child Solution 5 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13668059607",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029251",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802062626",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090208400",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090265900",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672407008",
      "ndc_label_name": "Cetirizine HCl SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991083704",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991083716",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838057280",
      "ndc_label_name": "Cetirizine HCl SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135005741",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135005747",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629206001",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629252101",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788828201",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043504",
      "ndc_label_name": "Cetirizine HCl Solution 1 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363701",
      "ndc_label_name": "Cetirizine HCl TABLET 10 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378363501",
      "ndc_label_name": "Cetirizine HCl TABLET 5 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47335034483",
      "ndc_label_name": "Cetirizine HCl TABLET CHEWABLE 10 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47335034383",
      "ndc_label_name": "Cetirizine HCl TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802072153",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054033425",
      "ndc_label_name": "Cevimeline HCl CAPSULE 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713093701",
      "ndc_label_name": "Cevimeline HCl Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571065710",
      "ndc_label_name": "Cevimeline HCl CAPSULE 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386099901",
      "ndc_label_name": "Cevimeline HCl Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304047901",
      "ndc_label_name": "Cevimeline HCl CAPSULE 30 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888011801",
      "ndc_label_name": "Cevimeline HCl Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102013001",
      "ndc_label_name": "Chateal Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102013003",
      "ndc_label_name": "Chateal Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102013010",
      "ndc_label_name": "Chateal Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102013048",
      "ndc_label_name": "Chateal Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55292020111",
      "ndc_label_name": "Chemet CAPSULE 100 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50924021807",
      "ndc_label_name": "Chemstrip 7 STRIP IN VITRO",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536131485",
      "ndc_label_name": "Chest Congestion Relief Liquid 100 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135017010",
      "ndc_label_name": "Childrens Chewable Vitamins Tablet Chewable Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54838010470",
      "ndc_label_name": "Childrens Silfedrine Liquid 15 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12830086416",
      "ndc_label_name": "Chlo Hist SOLUTION 12.5-1 MG/5ML ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12830076216",
      "ndc_label_name": "Chlo Tuss Liquid 30-1-12.5 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55146001109",
      "ndc_label_name": "Chlorella CAPSULE ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00116200104",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200115",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200116",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089300",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089316",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089340",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703580",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703587",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200103",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200105",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200203",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044701",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090072200",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061616",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061664",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687071464",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005257",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005269",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010601",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010650",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010699",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817304",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013815",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013817",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013819",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70166002603",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70166002715",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115279006",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440725304",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440725314",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980017750",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385014205",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115701009",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143212522",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440725404",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155085074",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063045440",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304046126",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980017802",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702001724",
      "ndc_label_name": "Chlorpheniramine Maleate ER Tablet Extended Release 12 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618002201",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00781402822",
      "ndc_label_name": "chlorproMAZINE HCl Concentrate 100 MG/ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338041024",
      "ndc_label_name": "chlorproMAZINE HCl Concentrate 100 MG/ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781402753",
      "ndc_label_name": "chlorproMAZINE HCl Concentrate 30 MG/ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338040312",
      "ndc_label_name": "chlorproMAZINE HCl Concentrate 30 MG/ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641139731",
      "ndc_label_name": "chlorproMAZINE HCl Solution 25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641139735",
      "ndc_label_name": "chlorproMAZINE HCl Solution 25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031801",
      "ndc_label_name": "chlorproMAZINE HCl Solution 25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031825",
      "ndc_label_name": "chlorproMAZINE HCl Solution 25 MG/ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641139831",
      "ndc_label_name": "chlorproMAZINE HCl Solution 50 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641139835",
      "ndc_label_name": "chlorproMAZINE HCl Solution 50 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031901",
      "ndc_label_name": "chlorproMAZINE HCl Solution 50 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031925",
      "ndc_label_name": "chlorproMAZINE HCl Solution 50 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296137",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781591301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030000",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601700",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689261",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904712961",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016211",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016215",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051801",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051820",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407043401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687041901",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687041911",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135042090",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304018501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462086101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238105401",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710112901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90096013101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440728630",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440728690",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296437",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296443",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781591601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030300",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030301",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030310",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030389",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602000",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602010",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602089",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689561",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904713261",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714005001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356009890",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090286500",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090602900",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016511",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016515",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051620",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407043701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045201",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045211",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135042390",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304011401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304011410",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462086401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238106001",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710113201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010691",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90096013401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296537",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296543",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781591701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030400",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030401",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030410",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030489",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602100",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602110",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602189",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689661",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904713361",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714005101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016611",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016612",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051720",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407043801",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687046301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687046311",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135042490",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304008301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304008310",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462086501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238106201",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710113301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010791",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90096013501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296237",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296243",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781591401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030100",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030101",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030110",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030189",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601810",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689361",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904713061",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004801",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090279100",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090596500",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016311",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016315",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051920",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407043501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043001",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043011",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135042190",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014310",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069610",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069612",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069614",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069615",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069620",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069621",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069624",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069628",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069630",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069640",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874069660",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462086201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238105601",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518160800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303400",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308600",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317500",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710113001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010491",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90096013201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440728530",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440728590",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296337",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527296343",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781591501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030200",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030201",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030210",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832030289",
      "ndc_label_name": "ChlorproMAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601900",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601910",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832601989",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689461",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904713161",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016411",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016415",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013020",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407043601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044111",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135042290",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304012201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304012210",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049410",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049412",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049414",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049415",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049420",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049421",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049424",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049428",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049430",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049440",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049445",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874049460",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462086301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238105801",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518001600",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518328000",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518332100",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518334800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710113101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010591",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90096013301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378022201",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378022210",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904690004",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904690061",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714012801",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714080001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300033301",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017010",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598071901",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598071910",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999065030",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090014401",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090014402",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319002",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090564301",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090564302",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090612601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090612602",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016711",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016715",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079005801",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079005820",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001850",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001870",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217010730",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217010790",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289006730",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664064888",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746076001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746076036",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031701",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031711",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031725",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031795",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135050530",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135050590",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332067631",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629848001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629876101",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057610",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057612",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057615",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057620",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874057630",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980030301",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980030310",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162024709",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689034599",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877069601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877069610",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382097001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382097010",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829409",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756001111",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756001112",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934047030",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002909",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002916",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002930",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002945",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002960",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002980",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610047230",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610047245",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610047260",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189035660",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834010901",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834010910",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021301",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021310",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714012901",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714080101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300033401",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353092209",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598016701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598016710",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598072001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598072010",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090014501",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224011850",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029730",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700058630",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664064988",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746076101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135050630",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135050690",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332067731",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629246501",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629876201",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929801",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980030401",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162025009",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689034699",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877069701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382097101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756002011",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756002012",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002109",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834011001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834011010",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000047701",
      "ndc_label_name": "Chocolated Laxative Tablet Chewable 15 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552089904",
      "ndc_label_name": "Cholesterol Powder",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00185093998",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806026998",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027095",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027098",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046663",
      "ndc_label_name": "Cholestyramine Light PACKET 4 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046665",
      "ndc_label_name": "Cholestyramine Light PACKET 4 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224000920",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629216101",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629946601",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877042260",
      "ndc_label_name": "Cholestyramine Light Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052960",
      "ndc_label_name": "Cholestyramine Light PACKET 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185093997",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027197",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046667",
      "ndc_label_name": "Cholestyramine Light POWDER 4 GM/DOSE ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224000910",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135093754",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629216201",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877042224",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052942",
      "ndc_label_name": "Cholestyramine Light POWDER 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185094098",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245053660",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245053689",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241013421",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241013436",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806026598",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806026695",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806026698",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046564",
      "ndc_label_name": "Cholestyramine PACKET 4 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046565",
      "ndc_label_name": "Cholestyramine PACKET 4 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001120",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629216301",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919701",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877029809",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877029860",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052860",
      "ndc_label_name": "Cholestyramine Packet 4 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185094097",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245053637",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241013451",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806026797",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884046566",
      "ndc_label_name": "Cholestyramine POWDER 4 GM/DOSE ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001110",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135000856",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559062037",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629216401",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919601",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877029837",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052842",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854032030",
      "ndc_label_name": "Chromagen CAPSULE ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713063815",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063818",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063831",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261076901",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013811",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013818",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013835",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999064615",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131801",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131802",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131808",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094563",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029717",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029735",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029792",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022501",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168031430",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168031460",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040046",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040049",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132303",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132304",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629252201",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030930",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030960",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054004421",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054004429",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093206406",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093206450",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185022305",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185022360",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440701760",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291045360",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017711",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017715",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013530",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013560",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505252201",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879501",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267129706",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267129760",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005106",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015706",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518220000",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518271400",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003753",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003760",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003780",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054002821",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093206506",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012360",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440701591",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017611",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017615",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013430",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217013460",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505252101",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879601",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005006",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015606",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518220800",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011660",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065065435",
      "ndc_label_name": "Ciloxan Ointment 0.3 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078084101",
      "ndc_label_name": "Ciloxan Ointment 0.3 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118996703",
      "ndc_label_name": "Ciloxan OINTMENT 0.3 % OPHTHALMIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502045093",
      "ndc_label_name": "Cimduo Tablet 300-300 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378619793",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706704",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007801",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044010",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044015",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010330",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045930",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096104",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036730",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335037983",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015311",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015312",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029530",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052511",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052521",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876301",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960801",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088304",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083105",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083130",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050330",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041002",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000704",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015201",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015030",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067430",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378619693",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007901",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044110",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044115",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010430",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046030",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096204",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036830",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335038083",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029630",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876401",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960701",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088404",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083205",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083230",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050430",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041102",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000804",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015301",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015130",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067530",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378619593",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008001",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044210",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044215",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010530",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046130",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096304",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036930",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060083",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029730",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876501",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960601",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088504",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083305",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083330",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050530",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041202",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000904",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015401",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015230",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067630",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00065853110",
      "ndc_label_name": "Cipro HC Suspension 0.2-1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078085526",
      "ndc_label_name": "Cipro HC Suspension 0.2-1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052710",
      "ndc_label_name": "Cipro HC SUSPENSION 0.2-1 % OTIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165600",
      "ndc_label_name": "Cipro HC Suspension 0.2-1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604300",
      "ndc_label_name": "Cipro HC Suspension 0.2-1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959072510",
      "ndc_label_name": "Cipro HC SUSPENSION 0.2-1 % OTIC",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419077301",
      "ndc_label_name": "Cipro Suspension Reconstituted 500 MG/5ML (10%) Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065853302",
      "ndc_label_name": "Ciprodex Suspension 0.3-0.1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078079975",
      "ndc_label_name": "Ciprodex Suspension 0.3-0.1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217007401",
      "ndc_label_name": "Ciprodex Suspension 0.3-0.1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205030975",
      "ndc_label_name": "Ciprodex Suspension 0.3-0.1 % Otic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012025",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012050",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071410",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071425",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261038101",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061401",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261091001",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999069925",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090088100",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090088200",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090175400",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090230200",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090231000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318400",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090421700",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090422000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436021001",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436065601",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436071401",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959055705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132001",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132002",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700011305",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700024505",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700063605",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118996805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021702",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021710",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065605",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065610",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065625",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919042105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919049105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919049125",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919049150",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079505",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079525",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187000105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098505",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098510",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874019903",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874019905",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071153005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788710005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788939105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994405",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030802",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030810",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518204500",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518239000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205030005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992701",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629040",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729040",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544014706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544014710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544014714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060414",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16252051401",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571041110",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714065102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039907",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039912",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039921",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039928",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261039960",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291021901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063041006",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063041010",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063041012",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063041014",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063041020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999033314",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090214600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090214601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090214602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090214603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090537100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073906",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073910",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073914",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073920",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027906",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027910",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027914",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027920",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012601",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012605",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154208600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700027906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700027910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700027914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700027920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657067501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864080606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864080614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864080620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052811",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442022201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442022210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037114",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135030801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132601",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132603",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132604",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132605",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132606",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132607",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132608",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739070010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205092714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007601",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005510",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005514",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005520",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005521",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005528",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071005530",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084006901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084006911",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758004",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788758008",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790503",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788900602",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788972402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117000801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518046400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518109000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518220202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205074920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040804",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040805",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040807",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040808",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335040809",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083604",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189032306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789000606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789019306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789019310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789019312",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789019314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789019320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030206",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030212",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030214",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021414",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021430",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143203701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992801",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378709801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629160",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629181",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629191",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729104",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729160",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729191",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904637861",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708361",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708395",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904724361",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544043210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060810",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544060820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544088406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544088420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544094320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107007701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16252051501",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571041210",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571041250",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714065202",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714065204",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016407",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016413",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016414",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016416",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016421",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016424",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016428",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016430",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016440",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016442",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261016460",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008128",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008160",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073330",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084630",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063042779",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054702",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054703",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054704",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054706",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054710",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054714",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054720",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054730",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054779",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063054782",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086908",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092302",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092328",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092330",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999033401",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086305",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086307",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086308",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164804",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164805",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164807",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164808",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164900",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379103",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379104",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379107",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385200",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090548300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090562100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090562800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436604101",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436604102",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079018201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079018220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016505",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073000",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073004",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073006",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073010",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073014",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073015",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073020",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073021",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073028",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073030",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073060",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026401",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026406",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026414",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026420",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026430",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018607",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018613",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018616",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018624",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217018628",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012701",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012705",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289082140",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060810",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060830",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118012708",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657067601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657067650",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864083310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864083320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429004220",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760007410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760007420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760067610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760067620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760081506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760081510",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760081520",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760081530",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442022301",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442022305",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005414",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005420",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005430",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005460",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135030901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135030905",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135030920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135030928",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001714",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001720",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001760",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101004",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101005",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101007",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629101008",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172403",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172404",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172405",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172406",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172407",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172408",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629172410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739055910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108604",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108605",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874108606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205092814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007701",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007705",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091906",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091910",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091914",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091920",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091928",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091930",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267091960",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007011",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788785708",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786403",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786404",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786408",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813608",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901200",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901201",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901202",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901208",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788902400",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788902401",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788902402",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788902408",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788922802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999030928",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117000901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117000902",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518001005",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036804",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036805",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518069300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518127801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518127803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518228601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518228602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518228603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518234100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518234103",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518234105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518234106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303500",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306302",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004510",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004514",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004530",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934009306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934009314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934009320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934031606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934031614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934031630",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205053610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205053614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205053620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064960",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205099755",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007000",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007001",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007002",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007003",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007004",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007005",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007006",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007007",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007008",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335007009",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335134703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335134704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335134706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335204603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610008118",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610008183",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610010930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610015983",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189024210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189024220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010810",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010828",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789010830",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789011801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789011820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004506",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004510",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004514",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004530",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425016401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425016402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992950",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16252051605",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571041305",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714065301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036707",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036721",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261036760",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356026410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073414",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073420",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073430",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073460",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012850",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442022450",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135031050",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187099010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187099030",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007850",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033114",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033120",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033130",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007111",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012550",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477711",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477723",
      "ndc_label_name": "Ciprofloxacin in D5W SOLUTION 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781323909",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781323946",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011482",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019282",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000000824",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000029724",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330001",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330024",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477702",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477721",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477750",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781324009",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781324048",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011487",
      "ndc_label_name": "Ciprofloxacin in D5W SOLUTION 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019287",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000000924",
      "ndc_label_name": "Ciprofloxacin in D5W SOLUTION 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000029824",
      "ndc_label_name": "Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950501",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703574811",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028838",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567051001",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781061023",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010365",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028332",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028333",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020651",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567051101",
      "ndc_label_name": "CISplatin SOLUTION 200 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010364",
      "ndc_label_name": "CISplatin SOLUTION 200 MG/200ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950401",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703574711",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028811",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567050901",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781060925",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010351",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028324",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028327",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020650",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054006258",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121169610",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121169640",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856007401",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722056424",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838054070",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60258083008",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135054047",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007424",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185037101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729590",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904608461",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000505",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668000901",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668000905",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668000909",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668000930",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002607",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002614",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002620",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002621",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002628",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002660",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002690",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008290",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806001901",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806001910",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063048105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063048130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090129800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090129801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090129802",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252000",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959060330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002157903",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458098116",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034201",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034205",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034230",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078760",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700078790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050713",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050788",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054305",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017310",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760000930",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760000990",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028830",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187022090",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000501",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000505",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000510",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084073701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084073711",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645056954",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681003",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681006",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681008",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681009",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082207",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082212",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518054200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518054201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518255300",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934039730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934039790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282020690",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282062810",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282062890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030901",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030902",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030903",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185037201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623201",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623205",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729390",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904608561",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544000630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544014930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017960",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544017990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000601",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000605",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001001",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001005",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001006",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722020710",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002760",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356072030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356072090",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806002001",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806002010",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063006314",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063006330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063006360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063006390",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063068330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063068360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063068390",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011615",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011645",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011660",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020815",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020845",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353077815",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353077830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353077845",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353077860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090089200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090089201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090089202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090089203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250102",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250103",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090277400",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324702",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324703",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643300",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643302",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643303",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436091602",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655068052",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959077330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959077352",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959077360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002135900",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002135903",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002135906",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217019100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217019130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217019160",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217019190",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458098016",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034301",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034305",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035690",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085190",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050813",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050818",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050888",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118116603",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864087714",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864087730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054401",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054405",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017401",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017410",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005630",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005660",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005690",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038930",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038960",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038990",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874111301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874111303",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874111306",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205020730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000601",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000605",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000610",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071023130",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071023152",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071023160",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071023190",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084074401",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084074411",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645057054",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788000503",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788080203",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788080209",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082307",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082312",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518007000",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518007001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518007002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518056100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518191700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518261700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934030490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934053930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934053990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023801",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023802",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023803",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023804",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023805",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335023806",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335071201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335071203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282020790",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282062910",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009302",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185037301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623301",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378623305",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729415",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729445",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904608661",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544018230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544018290",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107000705",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001108",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668001130",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002814",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261002890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008460",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806002101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806002110",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038590",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353009130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011253",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353048115",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353048145",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353048173",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057315",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057345",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999065430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999065490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090288800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313600",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313602",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320802",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517500",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517502",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436091701",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959098630",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002136000",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002136003",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002136006",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458088916",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034401",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034405",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034430",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050913",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050918",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664050988",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864081215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864081230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054601",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746054605",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017510",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039090",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919048030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874115700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874115703",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243021103",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243021109",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243030209",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031003",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031009",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031015",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031903",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031909",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243031945",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243038145",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243038409",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243038445",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000701",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000705",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000710",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862000730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544036030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090615",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090645",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090653",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090660",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090671",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544090673",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071022230",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645055954",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645057154",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789903",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789906",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789909",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788896201",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788896203",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788896206",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788896208",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788896209",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082407",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082412",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518044900",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518044901",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518135701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518135702",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518260100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518260101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518260102",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934009030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934034130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205076430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335048001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610041260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610041360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610042245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610042260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007190",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282020810",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282020890",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16500056015",
      "ndc_label_name": "Citracal +D3 TABLET CHEWABLE 250-107-500 MG-MG-UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16500054562",
      "ndc_label_name": "Citracal Calcium Gummies TABLET CHEWABLE 250-115-250 MG-MG-UNIT ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16500053505",
      "ndc_label_name": "Citracal Maximum Plus Tablet Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00555105456",
      "ndc_label_name": "Claravis CAPSULE 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105486",
      "ndc_label_name": "Claravis CAPSULE 10 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105556",
      "ndc_label_name": "Claravis Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105586",
      "ndc_label_name": "Claravis Capsule 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105660",
      "ndc_label_name": "Claravis Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105686",
      "ndc_label_name": "Claravis Capsule 30 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105756",
      "ndc_label_name": "Claravis Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555105786",
      "ndc_label_name": "Claravis Capsule 40 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729702",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729704",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729714",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729720",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729728",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729740",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527193006",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591280560",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261080820",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261080830",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291026360",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052014",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063094214",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090141000",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862019460",
      "ndc_label_name": "Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602246",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602252",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602346",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602352",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090099400",
      "ndc_label_name": "Clarithromycin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729604",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729614",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729620",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729628",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527193106",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781196160",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261063120",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356002514",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090244100",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329800",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017811",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017815",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237004460",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746074260",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061660",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034460",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380090503",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862022560",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054003721",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527193206",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781196260",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687204",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544095220",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061810",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061814",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061820",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061828",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061830",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061860",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261061890",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008620",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053014",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053020",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075214",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075220",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075228",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082320",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082328",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090414",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090420",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090430",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183000",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183001",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183002",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251500",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251501",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251502",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319300",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319301",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017911",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017913",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083610",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083614",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083620",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083660",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075610",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075614",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075620",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053514",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053520",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053530",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237004560",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864083720",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746074360",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043511",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043521",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760026114",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760026120",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064310",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064320",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064328",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061560",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034560",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037620",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037628",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629288701",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629288702",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629288703",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629288704",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380090603",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862022660",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033714",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033720",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033730",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084065125",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084065195",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788642501",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788642502",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788642503",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788642508",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693601",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693602",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693603",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693608",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712501",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712502",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712503",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712508",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793308",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277300",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001701",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001702",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001703",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001704",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001705",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001706",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001707",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001708",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079505",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149301",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149303",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149304",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149305",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149306",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149307",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149308",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149309",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029920",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029928",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440130040",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730004",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730017",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730040",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730056",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730060",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730090",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527138201",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591570801",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904595961",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015340",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015342",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015900",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015902",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015903",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015909",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015920",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015921",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015928",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015930",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015940",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015942",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015956",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015960",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015990",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261015999",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008812",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008828",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008830",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292001801",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292001820",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571025101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039404",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039406",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039415",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039417",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039420",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039421",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039428",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039430",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039440",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039442",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039456",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039460",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039480",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001100",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001104",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001115",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001118",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001130",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001140",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001160",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044300",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044304",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044307",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195100",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195103",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195104",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195106",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195107",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198500",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198501",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198503",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198504",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198506",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090198507",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322200",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466100",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466103",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466104",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466106",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466107",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018011",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018015",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959074420",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959074430",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959074440",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959074442",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023220",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023228",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023230",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023240",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023242",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023256",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023260",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023280",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023299",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348066028",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154682700",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032820",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032828",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700032830",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700090220",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864044120",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864060740",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864060760",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762332801",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760033708",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760033728",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760033760",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760048728",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760048760",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760057028",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005720",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005730",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005740",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919031030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187024721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187024728",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187024730",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187073821",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187073828",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187073830",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187073860",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304069201",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304069205",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281701",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281702",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281703",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281704",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281705",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281706",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281707",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281708",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629281709",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005910",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023501",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023504",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023510",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023512",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023515",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023516",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023520",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023521",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023528",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023530",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023540",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023556",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874023580",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862018501",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862018505",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006004",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006006",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006008",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006010",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006014",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006020",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006021",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006028",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006040",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006060",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084024301",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084024311",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462014301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462014305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646000",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646001",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646002",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646003",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646005",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646007",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788646008",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724000",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724001",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724002",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724003",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724005",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724007",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724008",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775300",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775302",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775303",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775306",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775307",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775308",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788970301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788970303",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994303",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042400",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042401",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042402",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042404",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042405",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005280",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014480",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934021630",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020000",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020001",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020002",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020003",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020004",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020005",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020006",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020007",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020008",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020009",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018004",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018008",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018015",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018020",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018021",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018028",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018040",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018042",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018056",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730520",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730528",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730540",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527138301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527138302",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591293201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904719461",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044814",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044816",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044818",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044820",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044821",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044828",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044830",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044840",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261044845",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008920",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358008930",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571025201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096700",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096701",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096702",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096703",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096704",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179800",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250200",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250202",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250203",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250204",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324200",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324202",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324203",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324204",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090457500",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090457501",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090457502",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090457503",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090457504",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018111",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018115",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018511",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268018515",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078404",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078416",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078421",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078428",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078430",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078440",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089001",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089004",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089009",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089015",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089020",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089021",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089028",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089030",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089040",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089056",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289089090",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700015521",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700015530",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700015540",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035821",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035828",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035830",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035840",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035845",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700076121",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700076130",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700076140",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762501001",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762501002",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760042730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760048410",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760048420",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760069310",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760069316",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760069320",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760069330",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919044120",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919044128",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919044130",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919044140",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919082921",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919082930",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919082940",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012728",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014121",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014128",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014130",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014140",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187038120",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187038121",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187038130",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187055628",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187055630",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187055640",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304069301",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304069316",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862018601",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544077528",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039806",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039814",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039820",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039830",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039840",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039845",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039890",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084024401",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084024411",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462014401",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788061604",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640101",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640102",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640103",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640104",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640105",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640106",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788640108",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730801",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730802",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730803",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730804",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730805",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730806",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788730808",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821901",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821902",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821903",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821904",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821905",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821906",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821908",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518215300",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518215301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518215302",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518215303",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518215304",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273500",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004830",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004840",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069330",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044421",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044428",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044430",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044440",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032000",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032001",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032002",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032003",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032004",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032005",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032006",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032007",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032008",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032009",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045300",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045301",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045302",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045303",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045304",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045305",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045306",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045307",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045308",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045309",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045400",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045401",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045402",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045403",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045404",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045405",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045406",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045407",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045408",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335045409",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335117101",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335141201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018930",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006915",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006920",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006921",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006928",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006930",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006940",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016709",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016721",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789020709",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789020720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789020721",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789020730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789020740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020212",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020220",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020230",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020260",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020290",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425010301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425014501",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425014502",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527138104",
      "ndc_label_name": "Clindamycin HCl Capsule 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571025001",
      "ndc_label_name": "Clindamycin HCl Capsule 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462014201",
      "ndc_label_name": "Clindamycin HCl Capsule 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574012901",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135056919",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714048301",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155060351",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762001601",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629239101",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629252301",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051110",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162046819",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862059601",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027740",
      "ndc_label_name": "Clindamycin Phosphate CREAM 2 % VAGINAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090138300",
      "ndc_label_name": "Clindamycin Phosphate Cream 2 % Vaginal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762500901",
      "ndc_label_name": "Clindamycin Phosphate CREAM 2 % VAGINAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168020230",
      "ndc_label_name": "Clindamycin Phosphate GEL 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020260",
      "ndc_label_name": "Clindamycin Phosphate GEL 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714016101",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714016102",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002705",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002707",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261042201",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802090094",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802090096",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076800",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595800",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607200",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139902",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139903",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374301",
      "ndc_label_name": "Clindamycin Phosphate GEL 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374302",
      "ndc_label_name": "Clindamycin Phosphate GEL 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863001",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930901",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086635",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086665",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682046275",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842306",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203003",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203006",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203107",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030030",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030060",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030275",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338341024",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338341050",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781328809",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781328891",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922009",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922091",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478012050",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 300 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338361224",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338361250",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338361624",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338361650",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781328909",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781328991",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922109",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922191",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478012150",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066099324",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572007401",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572007424",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 600 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338381424",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338381450",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338411424",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338411450",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781329009",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781329091",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922209",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781922291",
      "ndc_label_name": "Clindamycin Phosphate in D5W SOLUTION 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478012250",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066099524",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572007601",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572007624",
      "ndc_label_name": "Clindamycin Phosphate in D5W Solution 900 MG/50ML Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954524",
      "ndc_label_name": "Clindamycin Phosphate in NaCl SOLUTION 300-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954550",
      "ndc_label_name": "Clindamycin Phosphate in NaCl SOLUTION 300-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954924",
      "ndc_label_name": "Clindamycin Phosphate in NaCl SOLUTION 600-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954950",
      "ndc_label_name": "Clindamycin Phosphate in NaCl Solution 600-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338955324",
      "ndc_label_name": "Clindamycin Phosphate in NaCl SOLUTION 900-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338955350",
      "ndc_label_name": "Clindamycin Phosphate in NaCl Solution 900-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168020360",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714024601",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922003601",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802012801",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672140004",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118996406",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374401",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863201",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629945901",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704006",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020130",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020160",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069161",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000201",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000221",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802056201",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802056202",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999074930",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261100",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308600",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672408103",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672408104",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565001829",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565001859",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083781",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083783",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118996203",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863301",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863401",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695906",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705706",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781006",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799006",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123102",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123103",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71428000330",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71428000360",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008402",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008403",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25021011502",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 300 MG/2ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781045968",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028202",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081400",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081402",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611063401",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611063425",
      "ndc_label_name": "Clindamycin Phosphate Solution 300 MG/2ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011504",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 600 MG/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781046068",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781046369",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028204",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 600 MG/4ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081500",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081504",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611063901",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611063925",
      "ndc_label_name": "Clindamycin Phosphate Solution 600 MG/4ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011506",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 900 MG/6ML INJECTION",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781046168",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028206",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081600",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081606",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611064201",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611064225",
      "ndc_label_name": "Clindamycin Phosphate Solution 900 MG/6ML Injection",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011551",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 9000 MG/60ML INJECTION",
      "drug_tier": "Generic",
      "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": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113403",
      "ndc_label_name": "Clinimix/Dextrose (4.25/10) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338108904",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113303",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338109904",
      "ndc_label_name": "Clinimix/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113703",
      "ndc_label_name": "Clinimix/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338110104",
      "ndc_label_name": "Clinimix/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113803",
      "ndc_label_name": "Clinimix/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019801",
      "ndc_label_name": "Clinimix/Dextrose (6/5) Solution 6 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019806",
      "ndc_label_name": "Clinimix/Dextrose (6/5) Solution 6 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018801",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018806",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019401",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019404",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018001",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018006",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018401",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018404",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338050203",
      "ndc_label_name": "Clinisol SF SOLUTION 15 % Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338050206",
      "ndc_label_name": "Clinisol SF SOLUTION 15 % Intravenous",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954001",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954002",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954003",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954004",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954005",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954006",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954007",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954008",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054056150",
      "ndc_label_name": "cloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378804321",
      "ndc_label_name": "cloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527530164",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832058525",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008701",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672421008",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422708",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651040112",
      "ndc_label_name": "cloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052741",
      "ndc_label_name": "cloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689005804",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877065861",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015601",
      "ndc_label_name": "cloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153502",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011645",
      "ndc_label_name": "CloBAZam Suspension 2.5 MG/ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054052625",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527168101",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801301",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832058011",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088701",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722063901",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571031501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420201",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991090001",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042311",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042321",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877066501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015701",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238130501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011420",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710132501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054052725",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527168201",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801401",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832058111",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088801",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722064001",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571031601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420301",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991090101",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877066601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015801",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238130601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011520",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710132601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016315",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016330",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016346",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016360",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040015",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040030",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040045",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040060",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668056901",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668056902",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668056904",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668056905",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073001",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073002",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073003",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073004",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099201",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099202",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099203",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099204",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001604",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001605",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001606",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001607",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261045101",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261059801",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261072701",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261092901",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007615",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007630",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007645",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007660",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022130",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022145",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022160",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054800",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054900",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228900",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232400",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240500",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090382000",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507900",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090597900",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026715",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026730",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026745",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026760",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436998501",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125801",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125802",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125803",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125806",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565005115",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565005130",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565005145",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565005160",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084715",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002097863",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002097866",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002097868",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118002603",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090215",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090230",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090245",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090260",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054715",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054730",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054745",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332054760",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629232901",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233001",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233101",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233201",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629239201",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629239301",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629239401",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629239501",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980044103",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980044115",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980044145",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980044160",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180095601",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180095602",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180095603",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180095604",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052917",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052935",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052947",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052965",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721201",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721203",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721206",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153203",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153204",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153205",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153206",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512002860",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010915",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010916",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010917",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010918",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145601",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145602",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145603",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145604",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71085000760",
      "ndc_label_name": "Clobetasol Propionate CREAM 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015115",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026230",
      "ndc_label_name": "Clobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168030115",
      "ndc_label_name": "Clobetasol Propionate E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168030130",
      "ndc_label_name": "Clobetasol Propionate E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168030160",
      "ndc_label_name": "Clobetasol Propionate E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383027015",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383027030",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383027060",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129701",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129702",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129703",
      "ndc_label_name": "Clobetasol Propionate E Cream 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118989506",
      "ndc_label_name": "Clobetasol Propionate E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168029315",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168029330",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168029360",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802092514",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802092594",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802092596",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026915",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026930",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026960",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129401",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129402",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129403",
      "ndc_label_name": "Clobetasol Propionate GEL 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565008215",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565008230",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565008260",
      "ndc_label_name": "Clobetasol Propionate Gel 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016215",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016230",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016246",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168016260",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378819015",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378819030",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378819045",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378819060",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065615",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065631",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065637",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065660",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078201",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078202",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078203",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078204",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001704",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001705",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001706",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001707",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261072301",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261093001",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261097601",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007715",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007730",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007745",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007760",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386009660",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386009661",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386009662",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386009663",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026315",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138600",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319700",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464700",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640200",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026815",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026830",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026845",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026860",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125901",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125902",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125903",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125906",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565003915",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565003930",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565003945",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52565003960",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002099766",
      "ndc_label_name": "Clobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090115",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090130",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090145",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090160",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332046515",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332046530",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332046545",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332046560",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245501",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245601",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245701",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245801",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053017",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053035",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053047",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053065",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796301",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796303",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796306",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823801",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823803",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823806",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518117800",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010615",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010616",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010617",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700010618",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710140101",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710140102",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710140103",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710140104",
      "ndc_label_name": "Clobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026950",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040225",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472040250",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342032186",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571036281",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571036299",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386002860",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308500",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526400",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026625",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026650",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129302",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129303",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432013325",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432013350",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048625",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048650",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646050025",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646050050",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053228",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053253",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015304",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015320",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378302501",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406880601",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730730",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202701",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832063011",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703807",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069801",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068303",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068309",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084901",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084902",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084903",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021001",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021030",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063025730",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407031501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407075701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401105",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401106",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817028010",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038101",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038130",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038190",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071030",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071090",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429028701",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332040731",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629110901",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084079025",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084079095",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049201",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049206",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238110803",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238110809",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315016701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106503",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756040511",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091000",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091011",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091030",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091055",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091060",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091090",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72664021490",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378305001",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406880701",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730830",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781203701",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832063111",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703907",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069901",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068403",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068409",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085001",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085002",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085003",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021101",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021130",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034301",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034330",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407031601",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407075801",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401205",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401206",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817028110",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038290",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071130",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071190",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429028901",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332040831",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629111001",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629412301",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629412302",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084081825",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084081895",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049301",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049306",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238110903",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238110909",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315016601",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106601",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106603",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756040611",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091100",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091111",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091130",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091155",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091160",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091190",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72664021590",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378307501",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406880801",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440730930",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781204701",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832063211",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070001",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068503",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068509",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085101",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085102",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085103",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021201",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241021230",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034401",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571034430",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407031701",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407075901",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401305",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672401306",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817028210",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038301",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038330",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038390",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071230",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746071290",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429028801",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332040931",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629111101",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049401",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180049406",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111003",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111009",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315016501",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106701",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106703",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756040711",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091200",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091211",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091230",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091255",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091260",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205091290",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72664021690",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093083201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093083205",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300311",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300350",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191001",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191010",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191077",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732030",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732060",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732090",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732091",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801801",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801805",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801810",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904722761",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714046901",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714046902",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075202",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013600",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013616",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261034002",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261034030",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261034060",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261034090",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009020",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009030",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009060",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009090",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071901",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079730",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079760",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030710",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030714",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030715",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030720",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030728",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030745",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030746",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030753",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030754",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030755",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030760",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030770",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030775",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030780",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030792",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040610",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040611",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040650",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032815",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032890",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208800",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208802",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282300",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017311",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017315",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091301",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091302",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091305",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436136001",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436136002",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436294801",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436294802",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052401",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052405",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052412",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052415",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052430",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052445",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052451",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052460",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052490",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000900",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000912",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000930",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000960",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000990",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217017902",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217017930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217017945",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217017960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217017990",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056401",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056430",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056460",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664027313",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118294806",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072299",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052405",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052412",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052415",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052445",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052451",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052490",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054411",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027360",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005830",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005860",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005890",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022630",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187060330",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120101",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120301",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739026310",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028601",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028604",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028615",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028620",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028628",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028630",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028660",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028672",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028674",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028677",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028690",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267070830",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267070856",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267070860",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267070890",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030115",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030130",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030145",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030153",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030155",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030160",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030170",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030175",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030180",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544030192",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052915",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052945",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052953",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052970",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052975",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052980",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069715",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069745",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069753",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069760",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069770",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069775",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544069780",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739402",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739403",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739406",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739409",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842002",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842003",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842006",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842009",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788994103",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788994106",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518129701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518129702",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180100",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180101",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518239200",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518239201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246700",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246702",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250700",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011301",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011302",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011303",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011304",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011305",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011306",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011307",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011308",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011309",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003915",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003945",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003953",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003955",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003970",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003975",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003980",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003992",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008410",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008414",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008415",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008420",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008428",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008445",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008453",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008454",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008455",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008470",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008475",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008480",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008492",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036810",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036814",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036815",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036820",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036828",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036830",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036845",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036853",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036854",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036855",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036860",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036870",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036875",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036880",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036892",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008130",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008160",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008190",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015200",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015205",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015230",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012501",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012502",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012503",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321201",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321205",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300411",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300450",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191201",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191210",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191277",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732130",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732160",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732190",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732191",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556701",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556705",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556710",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904772861",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047001",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047002",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075001",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075002",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013700",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013716",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002900",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002902",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002903",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002907",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002914",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002920",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002921",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002928",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002930",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002940",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002960",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261002990",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009120",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009130",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358009160",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072230",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072260",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072290",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079430",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079460",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027730",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027746",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027755",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027775",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027780",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030815",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030828",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030830",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030846",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030853",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030854",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030855",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030860",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030870",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030875",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030880",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040710",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040711",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040750",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202202",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090429900",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017411",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017415",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091503",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088201",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088220",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052505",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052512",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052545",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052590",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063000",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063002",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063018",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063030",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063060",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063090",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217018902",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217018930",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217018960",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217018990",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071130",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071160",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071190",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083060",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118294903",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072399",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052505",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052512",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052545",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052590",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055511",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030030",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005930",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005960",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005990",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048530",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048560",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048590",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187027330",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187027360",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187088830",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187088860",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629111601",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898801",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898802",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898803",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739026410",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028504",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028510",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028520",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028528",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028572",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028574",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028577",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874028590",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074828",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074830",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074860",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074884",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074890",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025615",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025630",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025645",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025646",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025653",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025655",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025660",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025670",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025675",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025680",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028915",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028930",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028945",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028946",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028953",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028955",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028960",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028970",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028975",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028980",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028990",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028992",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698902",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698903",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698906",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698908",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698909",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773802",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773803",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773806",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773808",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773809",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840102",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840103",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840106",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840108",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840109",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788949506",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788949509",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788994003",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788994006",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518152101",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518152102",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518233400",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518233401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314400",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314402",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052930",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002200",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002201",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002202",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002203",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002204",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002205",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002206",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002207",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002208",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002209",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184304",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004015",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004028",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004045",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004053",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004055",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004060",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004070",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004075",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004080",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008545",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008546",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008553",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008555",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008570",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008575",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008580",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036315",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036328",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036330",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036345",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036346",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036353",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036354",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036355",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036360",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036370",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036375",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036380",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036615",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036630",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036645",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036653",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036660",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036670",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031430",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015305",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015330",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013502",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013503",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321301",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321305",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300511",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300550",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191401",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378191405",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732230",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732260",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732290",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556901",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556905",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781556910",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047101",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047102",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075101",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075102",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013800",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013816",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261062802",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261062830",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261062860",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261062890",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078830",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079915",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079945",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079970",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040810",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040850",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051830",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051860",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296500",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313300",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017511",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017515",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088301",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088320",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052605",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052630",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052660",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052690",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076100",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076102",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076110",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076130",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076160",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53217024760",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664027508",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664027513",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664027518",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072401",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072405",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052605",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052630",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052660",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052690",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120701",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100201",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100203",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100204",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100206",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100208",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874100209",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267090430",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267090460",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267090490",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028815",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028830",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028845",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028853",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028860",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544028870",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041215",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041230",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041245",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041253",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041260",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041270",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041280",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718102",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718103",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718106",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718109",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155901",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155902",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518223200",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518223201",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248500",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248501",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248502",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248503",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248504",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033301",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002315",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002330",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002345",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002353",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002360",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002370",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007515",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007530",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007545",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007553",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007570",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036715",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036730",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036745",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036753",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036760",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039015",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039030",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039045",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039053",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039060",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039070",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031530",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015400",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015401",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015405",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015430",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929019",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929067",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555009496",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030602",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030652",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.125 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664078386",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036406",
      "ndc_label_name": "ClonazePAM Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929119",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929167",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555009596",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030702",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030752",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664078486",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036506",
      "ndc_label_name": "ClonazePAM Tablet Dispersible 0.25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929219",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929267",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555009696",
      "ndc_label_name": "clonazePAM Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030802",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030852",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664078586",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036606",
      "ndc_label_name": "ClonazePAM Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929319",
      "ndc_label_name": "clonazePAM Tablet Dispersible 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929367",
      "ndc_label_name": "clonazePAM Tablet Dispersible 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555009796",
      "ndc_label_name": "clonazePAM Tablet Dispersible 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030902",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884030952",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664078686",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036706",
      "ndc_label_name": "ClonazePAM Tablet Dispersible 1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929419",
      "ndc_label_name": "clonazePAM Tablet Dispersible 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093929467",
      "ndc_label_name": "clonazePAM Tablet Dispersible 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555009896",
      "ndc_label_name": "clonazePAM Tablet Dispersible 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031002",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031052",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664078786",
      "ndc_label_name": "ClonazePAM TABLET DISPERSIBLE 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036806",
      "ndc_label_name": "ClonazePAM Tablet Dispersible 2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212710",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228212750",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378015201",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378015210",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632505",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632581",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632585",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732515",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732592",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732594",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904565661",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013501",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013505",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013510",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300046801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300046805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300046810",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049502",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261049590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009200",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009230",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063081708",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063081715",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063081730",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063081760",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353066080",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547056510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547056511",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999012700",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999012704",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999012712",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999012720",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999012790",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190800",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190801",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190802",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190807",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190808",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090277500",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090436000",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090436001",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090436002",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090436007",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090436008",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557700",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557702",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557707",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557708",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079029901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079029920",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018000",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018010",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071800",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071805",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071812",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071830",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071840",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071860",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071890",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021415",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021430",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021460",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021490",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489021501",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489021510",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54738090701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54738090703",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154556100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700028630",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700070430",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700070490",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064710",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064750",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864011030",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864063328",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023201",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023299",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429092101",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429092105",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011311",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760002730",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760002790",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760002798",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760005730",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760005790",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760017830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760017890",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032105",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032110",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919026630",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919026660",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919026690",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060590",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071830",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071860",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071890",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005431",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005471",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005491",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187041912",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187041920",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132802",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132803",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132804",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629132806",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739006010",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047502",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047512",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047515",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047520",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047528",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047581",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006106",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006112",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006130",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006160",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006190",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006191",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001023700",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001023703",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714501",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714503",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714506",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714509",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788921203",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788921403",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035003",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089802",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089803",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089804",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518128301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196200",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196201",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196202",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196203",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196204",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518196205",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316200",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934027130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934027190",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079330",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079390",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934085130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057030",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057060",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205058812",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205058830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012100",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012101",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012102",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012103",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012104",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012105",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012106",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012107",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012108",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335012109",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335077701",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335077706",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789009108",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789009115",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789009130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789009160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228212810",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228212850",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018601",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018610",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632600",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632601",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632605",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632630",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632660",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632681",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632685",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632690",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732630",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732660",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732690",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732692",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732694",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904565761",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070905",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544004230",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015830",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544019990",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013601",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013605",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013610",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062315",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062330",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062360",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261062390",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009330",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009360",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092530",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015180",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353050960",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353050980",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353066160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353066180",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547056610",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547056611",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999025800",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999025890",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190900",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190905",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090190906",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090260000",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090260005",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090260006",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315105",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315106",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079030001",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079030020",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079030063",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018100",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018110",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959078830",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021515",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021530",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021560",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53217021590",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489021601",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489021610",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54738090801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54738090803",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289007415",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289007430",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289007460",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289007490",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700030930",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064801",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064810",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064850",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023305",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012401",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012411",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032201",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032205",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032210",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919026730",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919026760",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005531",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005571",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005591",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231601",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629275301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629275302",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629275303",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629926901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047402",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047410",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047412",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047414",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047415",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047420",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047421",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047424",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047428",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047430",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047440",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047460",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874047481",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006214",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006230",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006260",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006290",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006292",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001023800",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001023803",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726103",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726106",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726109",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738003",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738006",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738009",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788768503",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788768506",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788768509",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808003",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808006",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808009",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518195900",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518195901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205021830",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053902",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053903",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053904",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053905",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053906",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053907",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335053908",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228212910",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378019901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440632701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440732706",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904565861",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071001",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013701",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300013705",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092430",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092490",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353031609",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547056710",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999043800",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999043830",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191001",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298301",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079030101",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079030120",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018200",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817018210",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489021701",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54738090901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289097030",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064910",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657064950",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023405",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442032301",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005631",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332005671",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629231901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629928901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874101403",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874101406",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267046430",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267046460",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001023900",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816303",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816306",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816309",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518100000",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518181100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518181101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335005003",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044909",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087116",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087199",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591350804",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591350854",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045301",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045304",
      "ndc_label_name": "CloNIDine Patch Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087216",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087299",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591350904",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591350954",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045401",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045404",
      "ndc_label_name": "CloNIDine Patch Weekly 0.2 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087316",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378087399",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591351004",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591351054",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045501",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862045504",
      "ndc_label_name": "CloNIDine Patch Weekly 0.3 MG/24HR Transdermal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093731405",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093731456",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093731498",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378362705",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378362777",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629461",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668014105",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668014130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668014190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714005201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714005202",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714005203",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729021810",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729021815",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729021816",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722090105",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722090130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722090190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098700",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098730",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098760",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261098790",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342006007",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342006010",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342006015",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543071305",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543071310",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543071330",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543071390",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063037130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063037160",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063037190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353026930",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353026960",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089413",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089481",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089483",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130100",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130101",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090208200",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090208201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090259800",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090259801",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228012405",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228012410",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228012430",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228012490",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003210",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003230",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003290",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458088816",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111019605",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111019630",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111019690",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154538800",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700057090",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429030110",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429030130",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429030190",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505025302",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505025303",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505399203",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919000730",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073790",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62034001577",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862035701",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862035705",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862035730",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862035761",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862035790",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071153303",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084053601",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084053611",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645059090",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632403",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632406",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632409",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788723803",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788723806",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788723809",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764503",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764506",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764509",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770003",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770006",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770009",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819003",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819006",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819009",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117101001",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117101002",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117101003",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117101004",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367020005",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518040000",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518040001",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518047100",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518047102",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934070890",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205007330",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205007390",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335008001",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335008002",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335008003",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335008004",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058101",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058102",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058103",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058104",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335075201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335075202",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71399750005",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052760",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71717010103",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71717010109",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71717010150",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771012410",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771012430",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771012490",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002105",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002190",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378007001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032101",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003003",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003006",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003010",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003012",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089306",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404401",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 15 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475601",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629385901",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629385902",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015710",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011401",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025606",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107031901",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107031905",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404201",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404202",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087330",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087360",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475401",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629364601",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629364602",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629364603",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874124203",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874124206",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544081353",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015910",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011201",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063016412",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999067400",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404301",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404302",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087430",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087460",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475501",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629385801",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629385802",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874123903",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874123906",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544057930",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544057953",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544057960",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544076230",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544076253",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544076260",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015810",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011301",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "36800006200",
      "ndc_label_name": "Clotrimazole 3 CREAM 2 % VAGINAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126526",
      "ndc_label_name": "Clotrimazole Anti-Fungal Cream 1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00168013315",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168013330",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168013346",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904782231",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904782236",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917002801",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802043401",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802043411",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090056200",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090177000",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090257000",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090593100",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127501",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127502",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127506",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127507",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672200201",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672200202",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824006301",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959049315",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959049330",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959049345",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187055915",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267097930",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267098015",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68462018117",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018135",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018147",
      "ndc_label_name": "Clotrimazole CREAM 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788740202",
      "ndc_label_name": "Clotrimazole CREAM 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788821603",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69396000120",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70403092530",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70512010030",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518339600",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73715000401",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "79503010530",
      "ndc_label_name": "Clotrimazole Cream 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472022041",
      "ndc_label_name": "Clotrimazole Cream 1 % Vaginal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536118170",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135067181",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135067191",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13874002051",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672126003",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672203701",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52817080030",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54633001810",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54633001830",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70795802001",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70954003620",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399050001",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399050003",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00054414622",
      "ndc_label_name": "Clotrimazole TROCHE 10 MG MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054414623",
      "ndc_label_name": "Clotrimazole TROCHE 10 MG MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054814622",
      "ndc_label_name": "Clotrimazole TROCHE 10 MG MOUTH/THROAT",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010714",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010770",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010777",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154495100",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58864081435",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168025815",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168025846",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037915",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037945",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714049601",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714049602",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261049401",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261055701",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356012045",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074100",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090155800",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090235300",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090235700",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312100",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436454601",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404801",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404806",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063315",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063345",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002097463",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002097467",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700006115",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700052415",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118995904",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118995905",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009515",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629875801",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089815",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089845",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029817",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029855",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % EXTERNAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699001",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699004",
      "ndc_label_name": "Clotrimazole-Betamethasone CREAM 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838801",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841901",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518235200",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052415",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018215",
      "ndc_label_name": "Clotrimazole-Betamethasone Cream 1-0.05 % External",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093777201",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093777205",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093777219",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093777293",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378086001",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378086002",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378086005",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378086007",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440731790",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440731791",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781599201",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708761",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014201",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014216",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079092201",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079092220",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008601",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008605",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862027301",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862027305",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090201",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090205",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034713",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034788",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429099001",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429099005",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041501",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041511",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235901",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236001",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084601",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084605",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518339100",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518339101",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72721176005",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440501",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440505",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440519",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440593",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378097301",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378097302",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708861",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079074901",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079074920",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862027401",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862027405",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090301",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090305",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664021188",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042601",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042611",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236201",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084701",
      "ndc_label_name": "CloZAPine TABLET 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518335700",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518335701",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72721177005",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093435901",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435905",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435919",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435993",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378082501",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378082502",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440731560",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781598901",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708961",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014101",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014116",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092101",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092120",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008501",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027101",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027105",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090001",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090005",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664034588",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429098901",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687040401",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687040411",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084401",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72721172505",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440401",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440405",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440419",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440493",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378097201",
      "ndc_label_name": "CloZAPine TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378097202",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027201",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027205",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090101",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090105",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024188",
      "ndc_label_name": "CloZAPine TABLET 50 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687054801",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687054811",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629236101",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084501",
      "ndc_label_name": "CloZAPine TABLET 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72721175005",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093541901",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093541919",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093541984",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378381501",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028801",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028804",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 100 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093541601",
      "ndc_label_name": "cloZAPine Tablet Dispersible 12.5 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093308601",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093308619",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093308684",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537601",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537619",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537684",
      "ndc_label_name": "cloZAPine Tablet Dispersible 150 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093308701",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093308719",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093308784",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537701",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537719",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093537784",
      "ndc_label_name": "cloZAPine Tablet Dispersible 200 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093541701",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093541719",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093541784",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378381301",
      "ndc_label_name": "CloZAPine TABLET DISPERSIBLE 25 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021201",
      "ndc_label_name": "CloZAPine Tablet Dispersible 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021204",
      "ndc_label_name": "CloZAPine Tablet Dispersible 25 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "37205055065",
      "ndc_label_name": "Co Q-10 Capsule 100 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845013238",
      "ndc_label_name": "Co Q-10 Capsule 150 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205074970",
      "ndc_label_name": "Co Q-10 Capsule 200 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007914",
      "ndc_label_name": "Co Q-10 CAPSULE 300 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845016818",
      "ndc_label_name": "Co Q-10 Capsule 400 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904561646",
      "ndc_label_name": "Co Q-10 Capsule 50 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845014618",
      "ndc_label_name": "Co Q-10 Capsule 75 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007908",
      "ndc_label_name": "Co Q-10 Capsule 75 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268018611",
      "ndc_label_name": "Co Q10 CAPSULE 30 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205054972",
      "ndc_label_name": "Co Q10 Capsule 60 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00078056845",
      "ndc_label_name": "Coartem TABLET 20-120 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "96974000005",
      "ndc_label_name": "Coenzyme Q10 Capsule 10 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552064602",
      "ndc_label_name": "Coenzyme Q10 POWDER",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618011128",
      "ndc_label_name": "Colace Clear CAPSULE 50 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00254200801",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254200811",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378108601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378108693",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591256201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591256230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712004",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003902",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722089901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722089930",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292005401",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292005403",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037210",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017101",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017111",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018711",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018715",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045501",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045530",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038911",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038921",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216701",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079604",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079606",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071003",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071009",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993016502",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877058901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010000201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010000203",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710135101",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710135103",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031030",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068710",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068730",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049403",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024903",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033103",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591532501",
      "ndc_label_name": "Colchicine-Probenecid TABLET 0.5-500 MG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742026301",
      "ndc_label_name": "Colchicine-Probenecid Tablet 0.5-500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980014901",
      "ndc_label_name": "Colchicine-Probenecid Tablet 0.5-500 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000005701",
      "ndc_label_name": "Cold & Allergy Childrens Liquid 2-5 MG/10ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000051501",
      "ndc_label_name": "Cold & Flu Relief Daytime Capsule 10-5-325 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000051601",
      "ndc_label_name": "Cold & Flu Relief Nighttime Capsule 15-6.25-325 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63868022820",
      "ndc_label_name": "Cold Relief Plus TABLET EFFERVESCENT 2-7.8-325 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68093007514",
      "ndc_label_name": "Coleman Insect Repel High&Dry Aerosol 25 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68093000747",
      "ndc_label_name": "Coleman SkinSmart Insect Repel Aerosol External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68093000746",
      "ndc_label_name": "Coleman SkinSmart Insect Repel Liquid External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00115186418",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115186430",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713093530",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51660099530",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629886001",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877052330",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462062030",
      "ndc_label_name": "Colesevelam HCl Packet 3.75 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115132019",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713093681",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808019001",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291014718",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598023018",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090437100",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407015918",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033618",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51660099628",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038525",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038595",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629244601",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629876701",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050651",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382061928",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462043318",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452015825",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162184602",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834015218",
      "ndc_label_name": "Colesevelam HCl Tablet 625 MG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115521302",
      "ndc_label_name": "Colestipol HCl GRANULES 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762026003",
      "ndc_label_name": "Colestipol HCl GRANULES 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115521218",
      "ndc_label_name": "Colestipol HCl PACKET 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115521229",
      "ndc_label_name": "Colestipol HCl PACKET 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762026001",
      "ndc_label_name": "Colestipol HCl PACKET 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762026002",
      "ndc_label_name": "Colestipol HCl PACKET 5 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115214216",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115521116",
      "ndc_label_name": "Colestipol HCl TABLET 1 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762045001",
      "ndc_label_name": "Colestipol HCl TABLET 1 GM ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687071511",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687071521",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518269300",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518269301",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146707",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021015910",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Generic",
      "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": "Generic",
      "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": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822061701",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "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": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023921105",
      "ndc_label_name": "Combigan Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023921110",
      "ndc_label_name": "Combigan Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023921115",
      "ndc_label_name": "Combigan Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597002402",
      "ndc_label_name": "Combivent Respimat Aerosol Solution 20-100 MCG/ACT Inhalation",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388001214",
      "ndc_label_name": "Cometriq (100 MG Daily Dose) Kit 80 & 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388001114",
      "ndc_label_name": "Cometriq (140 MG Daily Dose) Kit 3 x 20 MG & 80 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388001314",
      "ndc_label_name": "Cometriq (60 MG Daily Dose) Kit 20 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08396801400",
      "ndc_label_name": "Comfort Assist Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396801401",
      "ndc_label_name": "Comfort Assist Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61958110101",
      "ndc_label_name": "Complera TABLET 200-25-300 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574722612",
      "ndc_label_name": "Compro SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090288102",
      "ndc_label_name": "Compro Suppository 25 MG Rectal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629844401",
      "ndc_label_name": "Compro Suppository 25 MG Rectal",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54859080204",
      "ndc_label_name": "Conex Cold/Allergy SOLUTION 1-30 MG/5ML ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54859070260",
      "ndc_label_name": "Conex Cold/Allergy TABLET 2-60 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45963043963",
      "ndc_label_name": "Constulose SOLUTION 10 GM/15ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963043965",
      "ndc_label_name": "Constulose SOLUTION 10 GM/15ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090343600",
      "ndc_label_name": "Constulose Solution 10 GM/15ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71779011502",
      "ndc_label_name": "Copiktra Capsule 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71779011503",
      "ndc_label_name": "Copiktra Capsule 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73116021556",
      "ndc_label_name": "Copiktra Capsule 15 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71779012502",
      "ndc_label_name": "Copiktra Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71779012504",
      "ndc_label_name": "Copiktra Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73116022556",
      "ndc_label_name": "Copiktra Capsule 25 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513081301",
      "ndc_label_name": "Corlanor Solution 5 MG/5ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513081328",
      "ndc_label_name": "Corlanor Solution 5 MG/5ML Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513080060",
      "ndc_label_name": "Corlanor TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330900",
      "ndc_label_name": "Corlanor Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513081060",
      "ndc_label_name": "Corlanor TABLET 7.5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000033201",
      "ndc_label_name": "Corn & Callus Remover Liquid 17 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89269045426",
      "ndc_label_name": "Coromega Omega 3 Squeeze EMULSION ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13811006610",
      "ndc_label_name": "Corvita 150 Tablet 150-1.25 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13811002810",
      "ndc_label_name": "Corvita Tablet Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68025006030",
      "ndc_label_name": "Corvite Fe TABLET ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242071701",
      "ndc_label_name": "Cotellic TABLET 20 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000032401",
      "ndc_label_name": "Cough & Cold HBP TABLET 4-30 MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536118497",
      "ndc_label_name": "Cough/Chest Congestion DM Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00032121201",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032121207",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032122401",
      "ndc_label_name": "Creon CAPSULE DELAYED RELEASE PARTICLES 24000-76000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032122407",
      "ndc_label_name": "Creon CAPSULE DELAYED RELEASE PARTICLES 24000-76000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032120370",
      "ndc_label_name": "Creon CAPSULE DELAYED RELEASE PARTICLES 3000-9500 UNIT ORAL",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032301613",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032301628",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032120601",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00032120607",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11701006722",
      "ndc_label_name": "Critic-Aid Clear AF Ointment 2 % External",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57782039726",
      "ndc_label_name": "Cromolyn Sodium Aerosol Solution 5.2 MG/ACT Nasal",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16571060096",
      "ndc_label_name": "Cromolyn Sodium CONCENTRATE 100 MG/5ML ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571013221",
      "ndc_label_name": "Cromolyn Sodium CONCENTRATE 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571013252",
      "ndc_label_name": "Cromolyn Sodium CONCENTRATE 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51525047008",
      "ndc_label_name": "Cromolyn Sodium Concentrate 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51525047009",
      "ndc_label_name": "Cromolyn Sodium Concentrate 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629248501",
      "ndc_label_name": "Cromolyn Sodium Concentrate 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784020096",
      "ndc_label_name": "Cromolyn Sodium CONCENTRATE 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002596",
      "ndc_label_name": "Cromolyn Sodium Concentrate 100 MG/5ML Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172640649",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571035009",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48102003312",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48102003360",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784020530",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784020560",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Generic",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478029111",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999072010",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090120200",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304200",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312500",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023710",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205008510",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205023010",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904958",
      "ndc_label_name": "Cryselle-28 TABLET 0.3-30 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904979",
      "ndc_label_name": "Cryselle-28 TABLET 0.3-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356037028",
      "ndc_label_name": "Cryselle-28 TABLET 0.3-30 MG-MCG ORAL",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090218300",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788844202",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Generic",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49100040059",
      "ndc_label_name": "Culturelle Digestive Womens Capsule Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49100040102",
      "ndc_label_name": "Culturelle Prenatal Wellness Tablet Chewable Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428037128",
      "ndc_label_name": "CVS E Oil Oil 45 MG/0.25ML Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428218362",
      "ndc_label_name": "CVS Gauze Sterile PAD 2\"X2\"",
      "drug_tier": "Brand",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428046055",
      "ndc_label_name": "CVS Slow Release Iron Tablet Extended Release 143 (45 Fe) MG Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428043673",
      "ndc_label_name": "CVS Triple Magnesium Complex CAPSULE 400 MG ORAL",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428032862",
      "ndc_label_name": "CVS Vitamin E Capsule 268 MG (400 UNIT) Oral",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552104509",
      "ndc_label_name": "Cyanocobalamin Crystals",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144050101",
      "ndc_label_name": "Cyanocobalamin Powder",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457039910",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML Injection",
      "drug_tier": "Non-Medicare Rx/OTC",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00179005730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440135009",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735004",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735006",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735009",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735012",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735015",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735021",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735081",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735085",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735089",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735209",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735221",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735281",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735285",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440735290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591565801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591565805",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591565810",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904780961",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135059501",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135059505",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135059510",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007202",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007214",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007220",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007221",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007245",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007284",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544007290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544015930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000701",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000703",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000705",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000710",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000750",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052800",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052845",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052860",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052871",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052881",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052885",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052890",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078310",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078350",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041519",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003310",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003314",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003321",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003325",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003328",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003340",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003345",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003350",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261003390",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009720",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009728",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009760",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358009790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356065301",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356065307",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356065312",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356065315",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015410",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015412",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015418",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015427",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015430",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015445",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015460",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015490",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051603",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051604",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051606",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051609",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051610",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051612",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051614",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051615",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051620",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051621",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051630",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051640",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051642",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051660",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051682",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051690",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063051695",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018321",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018345",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018353",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018380",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018392",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547040010",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547040011",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547040050",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090260501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090260508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264400",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264404",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264406",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264407",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264408",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090264409",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090267800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090286200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316303",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316304",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316306",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316308",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316309",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090332901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090402401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090402402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571104",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571106",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571108",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571208",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090571300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090577200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589500",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589507",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589608",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090590000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268019111",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268019115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040002",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436040103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436084601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436084602",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436084603",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436084604",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079064401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079064420",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817019100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817019110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817033200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817033210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817033250",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004200",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004202",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004204",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004207",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004210",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004212",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004214",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004215",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004220",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004221",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004225",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004228",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004230",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004235",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004240",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004245",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004260",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959004290",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002030815",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002030821",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002030830",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348010809",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348010810",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289056717",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022921",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700022990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031121",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700031190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045921",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700045990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059910",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059921",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700059990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864012820",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864012830",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58864012845",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746017706",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746017710",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005218",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005227",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005245",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429005290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687055801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687055811",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041804",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041810",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041815",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041820",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041821",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041830",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041860",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760041890",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088940",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006420",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006430",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006460",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006472",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006486",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006490",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006515",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006520",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006530",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006560",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006572",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006590",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053710",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053720",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053721",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053760",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053786",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001100",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001115",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001130",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001160",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001172",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001190",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015730",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015790",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034215",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034221",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034230",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034245",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034260",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187034290",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081210",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081215",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081220",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081221",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081230",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081245",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081260",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081290",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629120901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629121001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629121101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133906",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133908",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133910",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739053110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031505",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031507",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031512",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031514",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031518",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031521",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031524",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031525",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031528",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031535",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031540",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031542",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031545",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031550",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031556",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031575",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031576",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031580",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874031590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64205054130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162054110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162054111",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162054150",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243034503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243034506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65243034509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862019101",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862019105",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862019199",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006410",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006415",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006420",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006430",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006440",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006445",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006456",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006460",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006490",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267006491",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267077503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267077504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018045",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018053",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018070",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018080",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544018092",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025145",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025153",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025170",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025174",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025180",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544025192",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645051890",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788739809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816703",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816705",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816706",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788906902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788906903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788906905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788906906",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788906909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097084607",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097084615",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69336010511",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69512054110",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008202",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008204",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518008206",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063505",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518063509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278804",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278805",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278806",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278807",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278808",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518278809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518315900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518315901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518341500",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006315",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006330",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044220",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934044290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006521",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006545",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006572",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020172",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108906",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335108909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335126607",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335196201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335196203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335196206",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335196207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211004",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211005",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211006",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211007",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335211009",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71550010101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001645",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001653",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001670",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001692",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037945",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037953",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037980",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037992",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610042845",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008007",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008015",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008020",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008072",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003645",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003682",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003693",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003694",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003695",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003698",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004610",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004612",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004614",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001400",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001405",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420003390",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027112",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420027190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425001903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378077101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591325601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135059401",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000610",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702000650",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078250",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041305",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041319",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037707",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037710",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037712",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037714",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037720",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037721",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037725",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037728",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037740",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037750",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037760",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261037790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356084700",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049410",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049414",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049415",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049420",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049421",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049430",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049460",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049482",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049495",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547039910",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547039950",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999079100",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999079121",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090276100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090276101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090276102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090525600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268019011",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268019015",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436000601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436000603",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436000604",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436000605",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436980401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436980402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436980403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817019010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817019050",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817033010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817033050",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084600",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084610",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084615",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084620",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084621",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084630",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084640",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084642",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084645",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084660",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084690",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700000418",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052718",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052760",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700069601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700069618",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700069630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700069660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700069690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092618",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746021106",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746021110",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429087601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Brand",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429087605",
      "n