{
  "Profile_Information": {
    "public_name": "Pennsylvania",
    "state": "PENNSYLVANIA",
    "formulary_type": "Medicaid",
    "formulary_name": "194_620_763-Medispan",
    "formulary_id": 15096,
    "formulary_version": 6,
    "formulary_effective_date": "01/01/2020"
  },
  "Drug_Information": [
    {
      "ndc": "73796026785",
      "ndc_label_name": "10 Series BP Monitor/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796027854",
      "ndc_label_name": "10 Series BP Monitor/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796079192",
      "ndc_label_name": "10 Series+ BP Monitr/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904676130",
      "ndc_label_name": "12 Hour Nasal Decongestant Solution 0.05 % Nasal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113038810",
      "ndc_label_name": "12 Hour Nasal Spray SOLUTION 0.05 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517065722",
      "ndc_label_name": "1st Choice Lancets Super Thin",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517015722",
      "ndc_label_name": "1st Choice Lancets Thin",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517035722",
      "ndc_label_name": "1st Choice Lancets Ultra Thin",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517030722",
      "ndc_label_name": "1st Choice Lancets Ultra Thin",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517025736",
      "ndc_label_name": "1st Tier Unilet ComforTouch",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517065736",
      "ndc_label_name": "1st Tier Unilet ComforTouch",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036102",
      "ndc_label_name": "24HR Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036101",
      "ndc_label_name": "24HR Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036103",
      "ndc_label_name": "24HR Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036104",
      "ndc_label_name": "24HR Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672206200",
      "ndc_label_name": "3 Day Vaginal CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73796026710",
      "ndc_label_name": "3 Series BP Monitor/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796026629",
      "ndc_label_name": "3 Series BP Monitor/Wrist DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796027424",
      "ndc_label_name": "5 Series BP Monitor DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796026742",
      "ndc_label_name": "5 Series BP Monitor/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016564",
      "ndc_label_name": "50+ Adult Eye Health CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73796026760",
      "ndc_label_name": "7 Series BP Monitor/Upper Arm DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796026652",
      "ndc_label_name": "7 Series BP Monitor/Wrist DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000018001",
      "ndc_label_name": "8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000018003",
      "ndc_label_name": "8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000018004",
      "ndc_label_name": "8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000018002",
      "ndc_label_name": "8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800021778",
      "ndc_label_name": "8 Hour Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000030601",
      "ndc_label_name": "8HR Muscle Aches & Pain Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009163",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011635",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009167",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011646",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011648",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009166",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009165",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009168",
      "ndc_label_name": "A Thru Z Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009173",
      "ndc_label_name": "A Thru Z Advantage TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004653",
      "ndc_label_name": "A Thru Z High Potency TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004610",
      "ndc_label_name": "A Thru Z High Potency TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004612",
      "ndc_label_name": "A Thru Z High Potency TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005233",
      "ndc_label_name": "A Thru Z High Potency TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011644",
      "ndc_label_name": "A Thru Z Select 50+ Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011251",
      "ndc_label_name": "A Thru Z Select 50+ Mens TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009153",
      "ndc_label_name": "A Thru Z Select Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009171",
      "ndc_label_name": "A Thru Z Select Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011640",
      "ndc_label_name": "A Thru Z Select Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011643",
      "ndc_label_name": "A Thru Z Select Advanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007001",
      "ndc_label_name": "A Thru Z Select TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009172",
      "ndc_label_name": "A Thru Z Select TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011636",
      "ndc_label_name": "A Thru Z Select TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004609",
      "ndc_label_name": "A Thru Z Select TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005232",
      "ndc_label_name": "A Thru Z Select TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009170",
      "ndc_label_name": "A Thru Z Select TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011250",
      "ndc_label_name": "A Thru Z Select Ultimate Women TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917012691",
      "ndc_label_name": "A Thru Z Ultimate Mens TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005921",
      "ndc_label_name": "A-10000 CAPSULE 10000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694085301",
      "ndc_label_name": "A-Caro-25 CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31722056224",
      "ndc_label_name": "Abacavir Sulfate SOLUTION 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980040524",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904652304",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904652306",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020406",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071703",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097051403",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505358306",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002111",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002121",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020401",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007360",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722055760",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378410591",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993048230",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028806",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090030",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093538256",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573040230",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097036202",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028607",
      "ndc_label_name": "Abacavir-Lamivudine-Zidovudine TABLET 300-150-300 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "74312041783",
      "ndc_label_name": "ABC Plus Senior Adults 50+ TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000070",
      "ndc_label_name": "ABC Plus TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269017406",
      "ndc_label_name": "ABDEK Capsule Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59148004580",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 300 MG Intramuscular",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148003185",
      "ndc_label_name": "Abilify MyCite Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148003285",
      "ndc_label_name": "Abilify MyCite Tablet 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148002985",
      "ndc_label_name": "Abilify MyCite Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148003385",
      "ndc_label_name": "Abilify MyCite Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148003485",
      "ndc_label_name": "Abilify MyCite Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148003085",
      "ndc_label_name": "Abilify MyCite Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148000813",
      "ndc_label_name": "Abilify TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148000913",
      "ndc_label_name": "Abilify TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148000613",
      "ndc_label_name": "Abilify TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001013",
      "ndc_label_name": "Abilify TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001113",
      "ndc_label_name": "Abilify TABLET 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148000713",
      "ndc_label_name": "Abilify TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093112589",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57894015512",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143959721",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378692078",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505432701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68817013450",
      "ndc_label_name": "Abraxane SUSPENSION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00135020003",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135020005",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135020001",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10631011531",
      "ndc_label_name": "Absorica CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011569",
      "ndc_label_name": "Absorica CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011669",
      "ndc_label_name": "Absorica CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011631",
      "ndc_label_name": "Absorica CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013369",
      "ndc_label_name": "Absorica CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013331",
      "ndc_label_name": "Absorica CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011731",
      "ndc_label_name": "Absorica CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011769",
      "ndc_label_name": "Absorica CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013431",
      "ndc_label_name": "Absorica CAPSULE 35 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013469",
      "ndc_label_name": "Absorica CAPSULE 35 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011869",
      "ndc_label_name": "Absorica CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011831",
      "ndc_label_name": "Absorica CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42358010032",
      "ndc_label_name": "Abstral TABLET SUBLINGUAL 100 MCG SUBLINGUAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42358020032",
      "ndc_label_name": "Abstral TABLET SUBLINGUAL 200 MCG SUBLINGUAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42358030032",
      "ndc_label_name": "Abstral Tablet Sublingual 300 MCG Sublingual",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42358040032",
      "ndc_label_name": "Abstral TABLET SUBLINGUAL 400 MCG SUBLINGUAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42358060032",
      "ndc_label_name": "Abstral TABLET SUBLINGUAL 600 MCG SUBLINGUAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42358080032",
      "ndc_label_name": "Abstral TABLET SUBLINGUAL 800 MCG SUBLINGUAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13548013250",
      "ndc_label_name": "Acanya Gel 1.2-2.5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014901",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380076006",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014905",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014225",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014910",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012211",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012210",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781034201",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014025",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014710",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781034001",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012010",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014701",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075806",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012011",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014810",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012110",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075906",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014805",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014120",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012111",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014125",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014801",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781034101",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884058902",
      "ndc_label_name": "Accolate TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884059002",
      "ndc_label_name": "Accolate TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50924047602",
      "ndc_label_name": "Accu-Chek Active Glucose Cont Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702010110",
      "ndc_label_name": "Accu-Chek Aviva Plus KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702072310",
      "ndc_label_name": "Accu-Chek Aviva Plus KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702040810",
      "ndc_label_name": "Accu-Chek Aviva Plus STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702043810",
      "ndc_label_name": "Accu-Chek Aviva Plus STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702040710",
      "ndc_label_name": "Accu-Chek Aviva Plus STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702010710",
      "ndc_label_name": "Accu-Chek Aviva SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924035706",
      "ndc_label_name": "Accu-Chek Comfort Curve Linear SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924041102",
      "ndc_label_name": "Accu-Chek Comfort Curve SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924039002",
      "ndc_label_name": "Accu-Chek Comfort Curve SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702036910",
      "ndc_label_name": "Accu-Chek Compact Blue Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924030202",
      "ndc_label_name": "Accu-Chek Compact Glucose Cont LIQUID† IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924001901",
      "ndc_label_name": "Accu-Chek Compact Plus Care KIT",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702046810",
      "ndc_label_name": "Accu-Chek Compact Plus Control SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924098850",
      "ndc_label_name": "Accu-Chek Compact Plus STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924088401",
      "ndc_label_name": "Accu-Chek Compact Plus STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702028810",
      "ndc_label_name": "Accu-Chek FastClix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071310",
      "ndc_label_name": "Accu-Chek Guide Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702061710",
      "ndc_label_name": "Accu-Chek Guide KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702072910",
      "ndc_label_name": "Accu-Chek Guide KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702073110",
      "ndc_label_name": "Accu-Chek Guide Me Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071110",
      "ndc_label_name": "Accu-Chek Guide STRIP In Vitro",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071210",
      "ndc_label_name": "Accu-Chek Guide Strip In Vitro",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924091901",
      "ndc_label_name": "Accu-Chek Instant Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924045001",
      "ndc_label_name": "Accu-Chek Multiclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924098101",
      "ndc_label_name": "Accu-Chek Multiclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702048310",
      "ndc_label_name": "Accu-Chek Nano SmartView KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702056710",
      "ndc_label_name": "Accu-Chek Nano SmartView KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924007920",
      "ndc_label_name": "Accu-Chek Safe-T Pro Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924095120",
      "ndc_label_name": "Accu-Chek Safe-T Pro Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702048810",
      "ndc_label_name": "Accu-Chek SmartView Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702049310",
      "ndc_label_name": "Accu-Chek SmartView STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702049210",
      "ndc_label_name": "Accu-Chek SmartView STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924058001",
      "ndc_label_name": "Accu-Chek Soft Touch Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924058510",
      "ndc_label_name": "Accu-Chek Soft Touch Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924093720",
      "ndc_label_name": "Accu-Chek Soft Touch Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924095701",
      "ndc_label_name": "Accu-Chek Softclix Lancet Dev",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702012410",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924097110",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54868493100",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702015610",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00071053023",
      "ndc_label_name": "Accupril TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071053040",
      "ndc_label_name": "Accupril TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071053223",
      "ndc_label_name": "Accupril TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071053240",
      "ndc_label_name": "Accupril TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071053523",
      "ndc_label_name": "Accupril TABLET 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071052723",
      "ndc_label_name": "Accupril TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071052740",
      "ndc_label_name": "Accupril TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071022223",
      "ndc_label_name": "Accuretic TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071022023",
      "ndc_label_name": "Accuretic TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00071022323",
      "ndc_label_name": "Accuretic TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65702027510",
      "ndc_label_name": "Accutrend Glucose Control SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702045610",
      "ndc_label_name": "Accutrend Glucose STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702027410",
      "ndc_label_name": "Accutrend Glucose STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268005011",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378120001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162066910",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005015",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746066901",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378140001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162067010",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746067001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713011850",
      "ndc_label_name": "Acephen Suppository 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713011812",
      "ndc_label_name": "Acephen Suppository 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713011801",
      "ndc_label_name": "Acephen Suppository 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016401",
      "ndc_label_name": "Acephen Suppository 325 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016450",
      "ndc_label_name": "Acephen Suppository 325 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016412",
      "ndc_label_name": "Acephen Suppository 325 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016510",
      "ndc_label_name": "Acephen SUPPOSITORY 650 MG",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016506",
      "ndc_label_name": "Acephen Suppository 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016550",
      "ndc_label_name": "Acephen Suppository 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016512",
      "ndc_label_name": "Acephen Suppository 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713016501",
      "ndc_label_name": "Acephen Suppository 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055574",
      "ndc_label_name": "Acerola C-500 TABLET CHEWABLE 500 MG ORAL",
      "drug_tier": "Tier 3",
      "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": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802020326",
      "ndc_label_name": "Acetaminophen Childrens Suspension 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802020126",
      "ndc_label_name": "Acetaminophen Childrens Suspension 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031001",
      "ndc_label_name": "Acetaminophen Childrens TABLET CHEWABLE 160 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68084077725",
      "ndc_label_name": "Acetaminophen ER Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268005215",
      "ndc_label_name": "Acetaminophen ER Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268005211",
      "ndc_label_name": "Acetaminophen ER Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68084077795",
      "ndc_label_name": "Acetaminophen ER Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672051",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034110",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037302",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672024",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015101",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015102",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672059",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672060",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673059",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673061",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673080",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015001",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015301",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037305",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672040",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672080",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673060",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674959",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034150",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015104",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037303",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037304",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000044601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015002",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037301",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034101",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015003",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015103",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015105",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000044602",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000044603",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536121277",
      "ndc_label_name": "Acetaminophen Infants Suspension 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58657052016",
      "ndc_label_name": "Acetaminophen Liquid 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121065721",
      "ndc_label_name": "Acetaminophen SOLUTION 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673870",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121065700",
      "ndc_label_name": "Acetaminophen SOLUTION 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66689005499",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121065705",
      "ndc_label_name": "Acetaminophen SOLUTION 160 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673971",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66689005599",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121131400",
      "ndc_label_name": "Acetaminophen SOLUTION 325 MG/10.15ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121131411",
      "ndc_label_name": "Acetaminophen SOLUTION 325 MG/10.15ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121197121",
      "ndc_label_name": "Acetaminophen SOLUTION 650 MG/20.3ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66689005699",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904682076",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121197100",
      "ndc_label_name": "Acetaminophen SOLUTION 650 MG/20.3ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073230",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073233",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073200",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073030",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073032",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073033",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 650 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904677361",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070310",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904671950",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034001",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070301",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015201",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015202",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904671980",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536116401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034010",
      "ndc_label_name": "Acetaminophen TABLET 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070399",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739044001",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015203",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000015204",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904671960",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031203",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070510",
      "ndc_label_name": "Acetaminophen TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031202",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000041001",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000041002",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536117201",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536117210",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070501",
      "ndc_label_name": "Acetaminophen TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070601",
      "ndc_label_name": "Acetaminophen TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031201",
      "ndc_label_name": "Acetaminophen Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645070610",
      "ndc_label_name": "Acetaminophen TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000030901",
      "ndc_label_name": "Acetaminophen TABLET CHEWABLE 160 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00406048301",
      "ndc_label_name": "Acetaminophen-Codeine #2 TABLET 300-15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233721",
      "ndc_label_name": "Acetaminophen-Codeine #2 TABLET 300-15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005001",
      "ndc_label_name": "Acetaminophen-Codeine #2 TABLET 300-15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015001",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015010",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048462",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016101",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048423",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233832",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037201",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048401",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048410",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233821",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005901",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003310",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048403",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037211",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005999",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016120",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003311",
      "ndc_label_name": "Acetaminophen-Codeine #3 TABLET 300-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035005",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048501",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037301",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233928",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037311",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048505",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035010",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233921",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035001",
      "ndc_label_name": "Acetaminophen-Codeine #4 TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050400",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383007916",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383007906",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050404",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121100800",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383007905",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050405",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050416",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383007913",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121100812",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432024516",
      "ndc_label_name": "Acetaminophen-Codeine SOLUTION 120-12 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107005801",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-15 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084040111",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084040121",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402201",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083306",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054101",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904666361",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054111",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028801",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402301",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527105001",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083406",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069310",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517751003",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517750425",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069130",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069504",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330703",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069210",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517760425",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517761003",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069404",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330803",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517763003",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069030",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000037801",
      "ndc_label_name": "Acid Control Maximum Strength Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037701",
      "ndc_label_name": "Acid Control Maximum Strength Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660003626",
      "ndc_label_name": "Acid Controller Max St Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660003531",
      "ndc_label_name": "Acid Controller Original Str Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904772714",
      "ndc_label_name": "Acid Gone SUSPENSION 95-358 MG/15ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023201",
      "ndc_label_name": "Acid Reducer CAPSULE DELAYED RELEASE 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023203",
      "ndc_label_name": "Acid Reducer CAPSULE DELAYED RELEASE 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023202",
      "ndc_label_name": "Acid Reducer CAPSULE DELAYED RELEASE 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205068163",
      "ndc_label_name": "Acid Reducer Complete Tablet Chewable 10-800-165 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800019402",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37205086163",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800019471",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113019402",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800019451",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113014165",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37205061465",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800014165",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800014172",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037501",
      "ndc_label_name": "Acid Reducer Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037502",
      "ndc_label_name": "Acid Reducer Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660035260",
      "ndc_label_name": "Acid Reducer Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660035230",
      "ndc_label_name": "Acid Reducer Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "23594021001",
      "ndc_label_name": "AcipHex Sprinkle Capsule Sprinkle 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23594020501",
      "ndc_label_name": "AcipHex Sprinkle CAPSULE SPRINKLE 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856024330",
      "ndc_label_name": "Aciphex TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115175008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378702093",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794008008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089430",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093113556",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115175108",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166808",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093113856",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794008108",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166908",
      "ndc_label_name": "Acitretin Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115175308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093113656",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378702393",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794008308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089630",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536105656",
      "ndc_label_name": "Acne Medication 10 GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105875",
      "ndc_label_name": "Acne Medication 10 LOTION 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105556",
      "ndc_label_name": "Acne Medication 5 GEL 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105775",
      "ndc_label_name": "Acne Medication 5 LOTION 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50242014301",
      "ndc_label_name": "Actemra ACTPen Solution Auto-Injector 162 MG/0.9ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242013601",
      "ndc_label_name": "Actemra SOLUTION 200 MG/10ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242013701",
      "ndc_label_name": "Actemra SOLUTION 400 MG/20ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242013501",
      "ndc_label_name": "Actemra SOLUTION 80 MG/4ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242013801",
      "ndc_label_name": "Actemra Solution Prefilled Syringe 162 MG/0.9ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63004871001",
      "ndc_label_name": "Acthar Gel 80 UNIT/ML Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51028000128",
      "ndc_label_name": "Acti-Lance 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715510",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732150",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714120",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715510",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731125",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731325",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714320",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715710",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715710",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732350",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714220",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732250",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715610",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715610",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731225",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12539050001",
      "ndc_label_name": "Actical CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00023614501",
      "ndc_label_name": "Actigall Capsule 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544093001",
      "ndc_label_name": "Actigall Capsule 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42238011112",
      "ndc_label_name": "Actimmune SOLUTION 2000000 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42238011101",
      "ndc_label_name": "Actimmune Solution 2000000 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Tier 4",
      "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": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987011110",
      "ndc_label_name": "Actimmune SOLUTION 2000000 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459051230",
      "ndc_label_name": "Actiq Lozenge on a Handle 1200 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459051201",
      "ndc_label_name": "Actiq Lozenge on a Handle 1200 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459051601",
      "ndc_label_name": "Actiq Lozenge On A Handle 1600 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459051630",
      "ndc_label_name": "Actiq Lozenge on a Handle 1600 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050201",
      "ndc_label_name": "Actiq Lozenge on a Handle 200 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050230",
      "ndc_label_name": "Actiq Lozenge on a Handle 200 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050401",
      "ndc_label_name": "Actiq Lozenge on a Handle 400 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050430",
      "ndc_label_name": "Actiq Lozenge on a Handle 400 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050630",
      "ndc_label_name": "Actiq Lozenge on a Handle 600 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050601",
      "ndc_label_name": "Actiq Lozenge on a Handle 600 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050801",
      "ndc_label_name": "Actiq Lozenge on a Handle 800 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459050830",
      "ndc_label_name": "Actiq Lozenge on a Handle 800 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242008527",
      "ndc_label_name": "Activase SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242004413",
      "ndc_label_name": "Activase SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "91237000187",
      "ndc_label_name": "Active 1st Blood Lancets 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "28595043330",
      "ndc_label_name": "Active FE TABLET 75-1.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60846020101",
      "ndc_label_name": "Activella Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60846020201",
      "ndc_label_name": "Activella TABLET 1-0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60846023201",
      "ndc_label_name": "Activella Tablet 1-0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430047801",
      "ndc_label_name": "Actonel TABLET 150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430047802",
      "ndc_label_name": "Actonel TABLET 150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430047207",
      "ndc_label_name": "Actonel TABLET 35 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430047203",
      "ndc_label_name": "Actonel TABLET 35 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430047115",
      "ndc_label_name": "Actonel TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764015560",
      "ndc_label_name": "Actoplus Met TABLET 15-500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764015860",
      "ndc_label_name": "Actoplus Met TABLET 15-850 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764051030",
      "ndc_label_name": "Actoplus met XR Tablet Extended Release 24 Hour 15-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764031030",
      "ndc_label_name": "Actoplus met XR Tablet Extended Release 24 Hour 30-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764015104",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764030114",
      "ndc_label_name": "Actos TABLET 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764045124",
      "ndc_label_name": "Actos TABLET 45 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023927705",
      "ndc_label_name": "Acular LS SOLUTION 0.4 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023218105",
      "ndc_label_name": "Acular SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08463610501",
      "ndc_label_name": "Acura Control SOLUTION High In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463620501",
      "ndc_label_name": "Acura Control SOLUTION Low In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463600501",
      "ndc_label_name": "Acura Control SOLUTION Normal In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00023350730",
      "ndc_label_name": "Acuvail SOLUTION 0.45 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505004206",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011105",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010701",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076014601",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093894005",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904578961",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010711",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022905",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012401",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093894001",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011101",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093363020",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802004475",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573040315",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079055068",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672136002",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083596",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063031",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066802",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646030015",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462074635",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168082530",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591115930",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668051501",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668051502",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573040331",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066801",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332024830",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168082515",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063015",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079055067",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672136001",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646030030",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462074617",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378870006",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378870049",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083594",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472008216",
      "ndc_label_name": "Acyclovir SUSPENSION 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378871273",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383081016",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904579061",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006111",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093894305",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530601",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739068210",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079101",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012205",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012201",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093894301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006115",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530608",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011201",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010801",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010811",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079105",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011205",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079205",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011305",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079201",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530705",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011301",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012301",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530701",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010901",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093894701",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006211",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006215",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010911",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012305",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023367060",
      "ndc_label_name": "Aczone GEL 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023367090",
      "ndc_label_name": "Aczone GEL 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023520690",
      "ndc_label_name": "Aczone Gel 7.5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023520660",
      "ndc_label_name": "Aczone Gel 7.5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040015",
      "ndc_label_name": "Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040020",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040088",
      "ndc_label_name": "Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040089",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040058",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57665000101",
      "ndc_label_name": "Adagen Solution 250 UNIT/ML Intramuscular",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427049401",
      "ndc_label_name": "Adalat CC Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427049501",
      "ndc_label_name": "Adalat CC Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427049601",
      "ndc_label_name": "Adalat CC Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168042446",
      "ndc_label_name": "Adapalene CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802045384",
      "ndc_label_name": "Adapalene CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040355",
      "ndc_label_name": "Adapalene GEL 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093630195",
      "ndc_label_name": "Adapalene GEL 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781714270",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672137709",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993088448",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472012645",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993088445",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781714219",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672137706",
      "ndc_label_name": "Adapalene GEL 0.3 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472031038",
      "ndc_label_name": "Adapalene-Benzoyl Peroxide GEL 0.1-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781718270",
      "ndc_label_name": "Adapalene-Benzoyl Peroxide Gel 0.1-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802084601",
      "ndc_label_name": "Adapalene-Benzoyl Peroxide GEL 0.1-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136403",
      "ndc_label_name": "Adapalene-Benzoyl Peroxide GEL 0.1-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993086948",
      "ndc_label_name": "Adapalene-Benzoyl Peroxide GEL 0.1-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10885000305",
      "ndc_label_name": "Adasuve Aerosol Powder Breath Activated 10 MG Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10885000301",
      "ndc_label_name": "Adasuve Aerosol Powder Breath Activated 10 MG Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51144005001",
      "ndc_label_name": "Adcetris SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302046760",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011001",
      "ndc_label_name": "Adderall TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011201",
      "ndc_label_name": "Adderall TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011501",
      "ndc_label_name": "Adderall TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844012001",
      "ndc_label_name": "Adderall TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844013001",
      "ndc_label_name": "Adderall TABLET 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844010501",
      "ndc_label_name": "Adderall TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011701",
      "ndc_label_name": "Adderall TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038301",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038501",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038701",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038901",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092039101",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038101",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505394703",
      "ndc_label_name": "Adefovir Dipivoxil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000308",
      "ndc_label_name": "Adefovir Dipivoxil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58914001006",
      "ndc_label_name": "Adeks TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50419025001",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025003",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025091",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025103",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025191",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025101",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025291",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025203",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025201",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025391",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025303",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025301",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025403",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025401",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419025491",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72912052530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912053530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 35 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912054530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912055530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 55 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912057030",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 70 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912058530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 85 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08347200001",
      "ndc_label_name": "Adjustable Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42167001110",
      "ndc_label_name": "Adjustable Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08327007209",
      "ndc_label_name": "Adjustable Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000301",
      "ndc_label_name": "Adjustable Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00024574702",
      "ndc_label_name": "Adlyxin Solution Pen-injector 20 MCG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024574502",
      "ndc_label_name": "Adlyxin Starter Pack Pen-injector Kit 10 & 20 MCG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024592501",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592505",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592605",
      "ndc_label_name": "Admelog Solution 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592410",
      "ndc_label_name": "Admelog SOLUTION 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954601",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954801",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954901",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954701",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954810",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143954910",
      "ndc_label_name": "Adriamycin SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143927501",
      "ndc_label_name": "Adriamycin Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143927701",
      "ndc_label_name": "Adriamycin Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301811",
      "ndc_label_name": "Adrucil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301812",
      "ndc_label_name": "Adrucil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301912",
      "ndc_label_name": "Adrucil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301911",
      "ndc_label_name": "Adrucil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301511",
      "ndc_label_name": "Adrucil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703301513",
      "ndc_label_name": "Adrucil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000020301",
      "ndc_label_name": "Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000021801",
      "ndc_label_name": "Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000017801",
      "ndc_label_name": "Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011462",
      "ndc_label_name": "Adult One Daily Gummies TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00173069500",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069504",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069604",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069600",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069700",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173069704",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071622",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317420005",
      "ndc_label_name": "Advance Intuition Control Liquid Normal In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317410602",
      "ndc_label_name": "Advance Micro-Draw Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317410501",
      "ndc_label_name": "Advance Micro-Draw Normal Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018877",
      "ndc_label_name": "Advanced Mobile Lancet",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55571093592",
      "ndc_label_name": "Advanced Multi EA TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896086206",
      "ndc_label_name": "Advanced Stress Formula/Zinc TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016962",
      "ndc_label_name": "Advantage Care Electrolyte Ped SOLUTION Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00944305302",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305402",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304510",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305102",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304610",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 3000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304710",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 4000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305202",
      "ndc_label_name": "Advate SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "94046000153",
      "ndc_label_name": "Advocate Arm BPM DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000140",
      "ndc_label_name": "Advocate Arm BPM DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000141",
      "ndc_label_name": "Advocate Arm BPM DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000107",
      "ndc_label_name": "Advocate Blood Glucose Monitor DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000102",
      "ndc_label_name": "Advocate Blood Glucose Monitor DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000134",
      "ndc_label_name": "Advocate Blood Glucose System KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000104",
      "ndc_label_name": "Advocate Control Solution Liquid High In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000101",
      "ndc_label_name": "Advocate Control Solution Liquid Low In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000106",
      "ndc_label_name": "Advocate Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000109",
      "ndc_label_name": "Advocate Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000110",
      "ndc_label_name": "Advocate Lancets 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000105",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52982000604",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52982000600",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000197",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000117",
      "ndc_label_name": "Advocate Memory BP Monitor",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000103",
      "ndc_label_name": "Advocate Rapid-Safe Lancing",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000111",
      "ndc_label_name": "Advocate Redi-Code DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000112",
      "ndc_label_name": "Advocate Redi-Code DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000136",
      "ndc_label_name": "Advocate Redi-Code KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000126",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000157",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000113",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000124",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000139",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000160",
      "ndc_label_name": "Advocate Redi-Code+ Control SOLUTION High IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000158",
      "ndc_label_name": "Advocate Redi-Code+ Control SOLUTION Low IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000156",
      "ndc_label_name": "Advocate Redi-Code+ DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000188",
      "ndc_label_name": "Advocate Redi-Code+ DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000133",
      "ndc_label_name": "Advocate Redi-Code+ Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000187",
      "ndc_label_name": "Advocate Redi-Code+ Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000118",
      "ndc_label_name": "Advocate Safety Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000192",
      "ndc_label_name": "Advocate Safety Lancets 26G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000100",
      "ndc_label_name": "Advocate Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000116",
      "ndc_label_name": "Advocate Wrist BP Monitor",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00944462401",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462701",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462501",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462201",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462801",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462301",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462601",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 750 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70165000315",
      "ndc_label_name": "Adzenys ER Suspension Extended Release 1.25 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165002030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165002530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 15.7 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165003030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 18.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165000530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 3.1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165001030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 6.3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165001530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 9.4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351098810",
      "ndc_label_name": "AeroChamber Mini Chamber DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351098510",
      "ndc_label_name": "AeroChamber MV",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569229400",
      "ndc_label_name": "AeroChamber Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54868451900",
      "ndc_label_name": "AeroChamber Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68115063901",
      "ndc_label_name": "AeroChamber Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456315467",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090034800",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456074613",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351080810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351078810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Medium",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456074413",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351088810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456074513",
      "ndc_label_name": "AeroChamber Plus Flo-Vu w/Mask",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079810",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079850",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54868585200",
      "ndc_label_name": "AeroChamber Plus w/Mask",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569434400",
      "ndc_label_name": "AeroChamber Plus w/Mask Small",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54868513100",
      "ndc_label_name": "AeroChamber Plus w/Mask Small",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079510",
      "ndc_label_name": "AeroChamber w/FLOWSIGnal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079710",
      "ndc_label_name": "AeroChamber Z-Stat Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079750",
      "ndc_label_name": "AeroChamber Z-Stat Plus Chambr",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351080710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Large",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351078710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Medium",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351088710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Small",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351085810",
      "ndc_label_name": "AeroVent Plus DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351085850",
      "ndc_label_name": "AeroVent Plus DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38396031125",
      "ndc_label_name": "AF Lancets Super Thin",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00078062651",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062661",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062761",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062751",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062851",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062861",
      "ndc_label_name": "Afinitor Disperz TABLET SOLUBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056751",
      "ndc_label_name": "Afinitor TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078056761",
      "ndc_label_name": "Afinitor TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078059461",
      "ndc_label_name": "Afinitor Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078059451",
      "ndc_label_name": "Afinitor Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078056651",
      "ndc_label_name": "Afinitor Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078056661",
      "ndc_label_name": "Afinitor Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078062051",
      "ndc_label_name": "Afinitor Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078062061",
      "ndc_label_name": "Afinitor Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084988",
      "ndc_label_name": "Afirmelle Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332041711",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332041811",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332041910",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332041911",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332041810",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332041710",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031801",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031802",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031701",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031702",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031601",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031602",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031901",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332031902",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47918089190",
      "ndc_label_name": "Afrezza POWDER 12 UNIT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918090218",
      "ndc_label_name": "Afrezza POWDER 4 & 8 & 12 UNIT INHALATION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918087490",
      "ndc_label_name": "Afrezza POWDER 4 UNIT INHALATION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918087890",
      "ndc_label_name": "Afrezza POWDER 8 UNIT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918088018",
      "ndc_label_name": "Afrezza Powder 90 x 4 UNIT & 90x8 UNIT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918089818",
      "ndc_label_name": "Afrezza Powder 90 x 8 UNIT & 90x12 UNIT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085068301",
      "ndc_label_name": "Afrin Saline Nasal Mist SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69911047602",
      "ndc_label_name": "Afstyla KIT 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911048002",
      "ndc_label_name": "Afstyla KIT 1500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047702",
      "ndc_label_name": "Afstyla KIT 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047402",
      "ndc_label_name": "Afstyla KIT 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911048102",
      "ndc_label_name": "Afstyla KIT 2500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047802",
      "ndc_label_name": "Afstyla KIT 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047502",
      "ndc_label_name": "Afstyla KIT 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51285010388",
      "ndc_label_name": "Aftera TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69536010388",
      "ndc_label_name": "Aftera Tablet 1.5 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554402501",
      "ndc_label_name": "AgaMatrix AMP DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554403601",
      "ndc_label_name": "AgaMatrix AMP Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554201101",
      "ndc_label_name": "AgaMatrix Control SOLUTION High IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554376402",
      "ndc_label_name": "AgaMatrix Control SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554133301",
      "ndc_label_name": "AgaMatrix Control SOLUTION Normal IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554232001",
      "ndc_label_name": "AgaMatrix Jazz Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554318802",
      "ndc_label_name": "AgaMatrix Jazz Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554229701",
      "ndc_label_name": "AgaMatrix Jazz Wireless 2 KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554386401",
      "ndc_label_name": "AgaMatrix Presto KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554264901",
      "ndc_label_name": "AgaMatrix Presto KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554362901",
      "ndc_label_name": "AgaMatrix Presto KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554408801",
      "ndc_label_name": "AgaMatrix Presto Pro Meter DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554333702",
      "ndc_label_name": "AgaMatrix Presto Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554197101",
      "ndc_label_name": "AgaMatrix Ultra-Thin Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00597000160",
      "ndc_label_name": "Aggrenox CAPSULE EXTENDED RELEASE 12 HOUR 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55513084101",
      "ndc_label_name": "Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51709000605",
      "ndc_label_name": "Aimsco Lubricated",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134321001",
      "ndc_label_name": "Aimsco Twist Lancets 32G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134331001",
      "ndc_label_name": "Aimsco Twist Lancets 33G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59310081206",
      "ndc_label_name": "AirDuo RespiClick 113/14 Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310082206",
      "ndc_label_name": "AirDuo RespiClick 232/14 Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310080506",
      "ndc_label_name": "AirDuo RespiClick 55/14 Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462130045",
      "ndc_label_name": "Airzone Peak Flow Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490031024",
      "ndc_label_name": "Airzone Peak Flow Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51759020410",
      "ndc_label_name": "Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478023835",
      "ndc_label_name": "AK-Poly-Bac Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478006235",
      "ndc_label_name": "Akwa Tears OINTMENT 2-15-83 % OPHTHALMIC",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69639010101",
      "ndc_label_name": "Akynzeo CAPSULE 300-0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69639010201",
      "ndc_label_name": "Akynzeo Solution Reconstituted 235-0.25 MG Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208060105",
      "ndc_label_name": "Alaway Childrens Allergy SOLUTION 0.025 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24208060110",
      "ndc_label_name": "Alaway SOLUTION 0.025 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69097023772",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722093502",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710102108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54505005522",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52054055022",
      "ndc_label_name": "Albenza Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378412201",
      "ndc_label_name": "Albuterol Sulfate ER Tablet Extended Release 12 Hour 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378412401",
      "ndc_label_name": "Albuterol Sulfate ER Tablet Extended Release 12 Hour 8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093317431",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993001968",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254100752",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487950160",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020025",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827091",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827093",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950125",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020060",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827052",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827055",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020030",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950103",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020001",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383074120",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (5 MG/ML) 0.5% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487030101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699152",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346753",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346853",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699252",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990401",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990425",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990130",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 2.5 MG/0.5ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472082516",
      "ndc_label_name": "Albuterol Sulfate SYRUP 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065720",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094995",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065701",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029018",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378025501",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017605",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134401",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017601",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029010",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378025505",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044201",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094925",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057205",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057201",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017705",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017701",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044301",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095225",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134501",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029118",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095295",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029110",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026360",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130603",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026315",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130601",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030017",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030047",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030065",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026345",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130606",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026445",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131606",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029947",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131601",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131603",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029917",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026415",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029965",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026460",
      "ndc_label_name": "Alclometasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779754501",
      "ndc_label_name": "Alcoh-Glove Contoured Wipe PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779754401",
      "ndc_label_name": "Alcoh-Wipe SHEET",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57513000645",
      "ndc_label_name": "Alcohol Pads PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000128",
      "ndc_label_name": "Alcohol Pads PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777012114",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62850000001",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777012113",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69967000201",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777012116",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63517060001",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536750001",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000701",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42167000630",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000601",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40986001290",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68113099601",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536110301",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014296",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41520080930",
      "ndc_label_name": "Alcohol Prep Pad 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000801",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913001802",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913001702",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000702",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000902",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68113011401",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904624560",
      "ndc_label_name": "Alcohol Prep Pad PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536992001",
      "ndc_label_name": "Alcohol Preps PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000011201",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917008216",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904427760",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37205015578",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62451999810",
      "ndc_label_name": "Alcohol Swabs Pad",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113200078",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003175",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41520031367",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012807",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006104",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007088",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012805",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014455",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "19283059475",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "18407063115",
      "ndc_label_name": "Alcohol Swabstick PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "18407061115",
      "ndc_label_name": "Alcohol Swabstick PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "18407061105",
      "ndc_label_name": "Alcohol Swabstick Pad 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000002601",
      "ndc_label_name": "Alcohol Wipes 70 % External",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614062278",
      "ndc_label_name": "Alcohol Wipes PAD 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00025101131",
      "ndc_label_name": "Aldactazide TABLET 25-25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025103131",
      "ndc_label_name": "Aldactone TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025100131",
      "ndc_label_name": "Aldactone TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025104131",
      "ndc_label_name": "Aldactone TABLET 50 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "99207026012",
      "ndc_label_name": "Aldara CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468007001",
      "ndc_label_name": "Aldurazyme SOLUTION 2.9 MG/5ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013001",
      "ndc_label_name": "Alecensa CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224030110",
      "ndc_label_name": "Alendronate Sodium SOLUTION 70 MG/75ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167801",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167808",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034001",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063101",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063102",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167926",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167934",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013012",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335063768",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022376",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063202",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022316",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013004",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252059944",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76439013004",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252059902",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063201",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024202",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032804",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168008",
      "ndc_label_name": "Alendronate Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167608",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115167601",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063302",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024402",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032904",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022476",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013104",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013120",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022416",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335063868",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168126",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168134",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252060102",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252060144",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063301",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013112",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29978091860",
      "ndc_label_name": "Alevazol OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29300015519",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378500577",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002764001",
      "ndc_label_name": "Alimta SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002762301",
      "ndc_label_name": "Alimta SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437010601",
      "ndc_label_name": "Alinia Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419038501",
      "ndc_label_name": "Aliqopa SOLUTION RECONSTITUTED 60 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884042411",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993014130",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884042511",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993014230",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33674015692",
      "ndc_label_name": "Alive Once Daily Womens 50+ TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "33674060195",
      "ndc_label_name": "Alive Womens Energy TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "33674015903",
      "ndc_label_name": "Alive Womens Gummy TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52609300100",
      "ndc_label_name": "Alkeran SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36800097426",
      "ndc_label_name": "All Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000021401",
      "ndc_label_name": "All Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113097426",
      "ndc_label_name": "All Day Allergy Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904637220",
      "ndc_label_name": "All Day Allergy Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000018601",
      "ndc_label_name": "All Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800018926",
      "ndc_label_name": "All Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000021501",
      "ndc_label_name": "All Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800017662",
      "ndc_label_name": "All Day Allergy D Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585246",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045866",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000014804",
      "ndc_label_name": "All Day Allergy TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000038001",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585272",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000038002",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585243",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045813",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045887",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045895",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000014802",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000038004",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585241",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585260",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000014801",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000038003",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904585289",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045839",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045847",
      "ndc_label_name": "All Day Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000014803",
      "ndc_label_name": "All Day Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113017662",
      "ndc_label_name": "All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904583112",
      "ndc_label_name": "All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113217662",
      "ndc_label_name": "All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113017653",
      "ndc_label_name": "All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017102",
      "ndc_label_name": "All Day Pain Relief Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020101",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020104",
      "ndc_label_name": "All Day Pain Relief Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036862",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036871",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036882",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800049062",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017101",
      "ndc_label_name": "All Day Pain Relief Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017103",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036878",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800049078",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017104",
      "ndc_label_name": "All Day Pain Relief Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020102",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020103",
      "ndc_label_name": "All Day Pain Relief TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109306",
      "ndc_label_name": "All Day Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109401",
      "ndc_label_name": "All Day Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109406",
      "ndc_label_name": "All Day Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109301",
      "ndc_label_name": "All Day Relief TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800047526",
      "ndc_label_name": "All-Day Allergy Childrens SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536102547",
      "ndc_label_name": "Aller-Chlor SYRUP 2 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100610",
      "ndc_label_name": "Aller-Chlor TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100635",
      "ndc_label_name": "Aller-Chlor Tablet 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100601",
      "ndc_label_name": "Aller-Chlor TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113042553",
      "ndc_label_name": "Aller-Ease TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37205056526",
      "ndc_label_name": "Allergy Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63868082354",
      "ndc_label_name": "Allergy Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000012501",
      "ndc_label_name": "Allergy Childrens SYRUP 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025201",
      "ndc_label_name": "Allergy Childrens Syrup 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109201",
      "ndc_label_name": "Allergy Non-Drowsy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536109203",
      "ndc_label_name": "Allergy Non-Drowsy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020701",
      "ndc_label_name": "Allergy Relief CAPSULE 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113046262",
      "ndc_label_name": "Allergy Relief CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000014401",
      "ndc_label_name": "Allergy Relief CAPSULE 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000020702",
      "ndc_label_name": "Allergy Relief CAPSULE 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800037926",
      "ndc_label_name": "Allergy Relief Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000024502",
      "ndc_label_name": "Allergy Relief Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000024501",
      "ndc_label_name": "Allergy Relief Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113037926",
      "ndc_label_name": "Allergy Relief Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800037934",
      "ndc_label_name": "Allergy Relief Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000016202",
      "ndc_label_name": "Allergy Relief D-24 Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000016201",
      "ndc_label_name": "Allergy Relief D-24 Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000011001",
      "ndc_label_name": "Allergy Relief SUSPENSION 50 MCG/ACT Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113061239",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113061260",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800061246",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052605",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052611",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021305",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031701",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800061276",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021301",
      "ndc_label_name": "Allergy Relief TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021302",
      "ndc_label_name": "Allergy Relief TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052601",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113061246",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113061265",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800061287",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052631",
      "ndc_label_name": "Allergy Relief TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052653",
      "ndc_label_name": "Allergy Relief Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800061265",
      "ndc_label_name": "Allergy Relief TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021303",
      "ndc_label_name": "Allergy Relief TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021304",
      "ndc_label_name": "Allergy Relief TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021202",
      "ndc_label_name": "Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021203",
      "ndc_label_name": "Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000021201",
      "ndc_label_name": "Allergy Relief Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113047953",
      "ndc_label_name": "Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000013602",
      "ndc_label_name": "Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000013603",
      "ndc_label_name": "Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113047978",
      "ndc_label_name": "Allergy Relief TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000013601",
      "ndc_label_name": "Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113047962",
      "ndc_label_name": "Allergy Relief TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113004278",
      "ndc_label_name": "Allergy Relief Tablet 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000016001",
      "ndc_label_name": "Allergy Relief TABLET 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000016002",
      "ndc_label_name": "Allergy Relief TABLET 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000036201",
      "ndc_label_name": "Allergy Relief Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036202",
      "ndc_label_name": "Allergy Relief Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052731",
      "ndc_label_name": "Allergy Relief Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52544023954",
      "ndc_label_name": "Allergy Relief-D Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52544023912",
      "ndc_label_name": "Allergy Relief-D Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660072469",
      "ndc_label_name": "Allergy Relief/Nasal Decongest Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660072415",
      "ndc_label_name": "Allergy Relief/Nasal Decongest Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08287126062",
      "ndc_label_name": "Allergy Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904572887",
      "ndc_label_name": "Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904572889",
      "ndc_label_name": "Allergy TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904572872",
      "ndc_label_name": "Allergy Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800047979",
      "ndc_label_name": "Allergy TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800047967",
      "ndc_label_name": "Allergy TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800047962",
      "ndc_label_name": "Allergy TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800047978",
      "ndc_label_name": "Allergy TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904001224",
      "ndc_label_name": "Allergy Tablet 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904001280",
      "ndc_label_name": "Allergy TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904001261",
      "ndc_label_name": "Allergy TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800046362",
      "ndc_label_name": "Allergy TABLET 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904001259",
      "ndc_label_name": "Allergy TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205021578",
      "ndc_label_name": "Allergy TABLET 4 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483024201",
      "ndc_label_name": "Allergy-Time TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483024210",
      "ndc_label_name": "Allergy-Time TABLET 4 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113201352",
      "ndc_label_name": "Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113201360",
      "ndc_label_name": "Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113201339",
      "ndc_label_name": "Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00603211521",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013401",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020501",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098801",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554310",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004112",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015601",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739041010",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004107",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006311",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020520",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015605",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015610",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211532",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657161",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004110",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013416",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006315",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378013701",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378013710",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742013510",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098811",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018105",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211621",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211632",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006411",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020620",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071311",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739079610",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018101",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554405",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211628",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006415",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015710",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657261",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004211",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013501",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742013601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015705",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004210",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020601",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554401",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013516",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015701",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071301",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70362072201",
      "ndc_label_name": "Allzital Tablet 25-325 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536001583",
      "ndc_label_name": "Almacone Double Strength SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536002583",
      "ndc_label_name": "Almacone Suspension 200-200-20 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536118583",
      "ndc_label_name": "Almacone Suspension 200-200-20 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093526119",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378524632",
      "ndc_label_name": "Almotriptan Malate Tablet 12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378524685",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241004268",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093526129",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241004221",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093526018",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378524532",
      "ndc_label_name": "Almotriptan Malate Tablet 6.25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093526019",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378524585",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241004111",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023884205",
      "ndc_label_name": "Alocril SOLUTION 2 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43553000305",
      "ndc_label_name": "Aloe Vesta Clear Antifungal OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802010365",
      "ndc_label_name": "Alogliptin Benzoate TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802015065",
      "ndc_label_name": "Alogliptin Benzoate TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802008765",
      "ndc_label_name": "Alogliptin Benzoate TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802021172",
      "ndc_label_name": "Alogliptin-Metformin HCl TABLET 12.5-1000 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802016972",
      "ndc_label_name": "Alogliptin-Metformin HCl TABLET 12.5-500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802023865",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 12.5-15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802026065",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 12.5-30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802030465",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 12.5-45 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802035165",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 25-15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040265",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 25-30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802049965",
      "ndc_label_name": "Alogliptin-Pioglitazone TABLET 25-45 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00065034510",
      "ndc_label_name": "Alomide SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023588512",
      "ndc_label_name": "Alora Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023588502",
      "ndc_label_name": "Alora Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544088454",
      "ndc_label_name": "Alora Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047108",
      "ndc_label_name": "Alora Patch Twice Weekly 0.05 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047154",
      "ndc_label_name": "Alora Patch Twice Weekly 0.05 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047254",
      "ndc_label_name": "Alora Patch Twice Weekly 0.075 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047208",
      "ndc_label_name": "Alora Patch Twice Weekly 0.075 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047308",
      "ndc_label_name": "Alora Patch Twice Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544047354",
      "ndc_label_name": "Alora Patch Twice Weekly 0.1 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054029513",
      "ndc_label_name": "Alosetron HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "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": "Tier 2",
      "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": "Tier 2",
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162024903",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963048003",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884082011",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054029613",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856079701",
      "ndc_label_name": "Aloxi Solution 0.25 MG/5ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11694099401",
      "ndc_label_name": "Alph-E CAPSULE 400 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694099403",
      "ndc_label_name": "Alph-E CAPSULE 400 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694088604",
      "ndc_label_name": "Alph-E-Mixed 1000 CAPSULE 1000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694092401",
      "ndc_label_name": "Alph-E-Mixed CAPSULE 200 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694092301",
      "ndc_label_name": "Alph-E-Mixed CAPSULE 400 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00023932110",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932105",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932115",
      "ndc_label_name": "Alphagan P SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917710",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917715",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917705",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461302",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460302",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460402",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461402",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460902",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461502",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461101",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460101",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460201",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461201",
      "ndc_label_name": "Alphanate/VWF Complex/Human SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360202",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360802",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360302",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360902",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360102",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360702",
      "ndc_label_name": "AlphaNine SD SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862045460",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093545006",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308306",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308406",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045560",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093545106",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093545206",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045660",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308706",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045760",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093545306",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308606",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054306844",
      "ndc_label_name": "ALPRAZolam Intensol CONCENTRATE 1 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060318",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739064410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090009",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090011",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064711",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011032",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070405",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371904",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067699",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202796",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106105",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371901",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202710",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106110",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060313",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078801",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371903",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202750",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060388",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090050",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064701",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011020",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400105",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106101",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078820",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070401",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090010",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202996",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060418",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107710",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585961",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070510",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739066910",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090111",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090150",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011132",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202950",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078901",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372003",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090110",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202910",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400305",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078920",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070505",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372001",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067799",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084067201",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107701",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372004",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084067211",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011120",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107705",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060413",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011130",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067899",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011220",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011232",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203150",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107901",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904586061",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090210",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203110",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400505",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107910",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079001",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739067410",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090211",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090250",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203196",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372104",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079020",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070610",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372103",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107905",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060513",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060588",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372101",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070701",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372201",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070705",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378400701",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060688",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090350",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203910",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108901",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253090310",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011320",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372203",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011330",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228401911",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011074",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011052",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011152",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402211",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011174",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402411",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021374",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021352",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402511",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021452",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021474",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005701",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005901",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762006601",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762006801",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71104092201",
      "ndc_label_name": "Alprolix Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104093301",
      "ndc_label_name": "Alprolix Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104096601",
      "ndc_label_name": "Alprolix Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104094401",
      "ndc_label_name": "Alprolix Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104097701",
      "ndc_label_name": "Alprolix Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104091101",
      "ndc_label_name": "Alprolix Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208035310",
      "ndc_label_name": "Alrex SUSPENSION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208035305",
      "ndc_label_name": "Alrex SUSPENSION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61570011001",
      "ndc_label_name": "Altace CAPSULE 1.25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61570012001",
      "ndc_label_name": "Altace CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61570011101",
      "ndc_label_name": "Altace CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61570011201",
      "ndc_label_name": "Altace CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59390003520",
      "ndc_label_name": "Altamist Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59390003526",
      "ndc_label_name": "Altamist Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70700011685",
      "ndc_label_name": "Altavera Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38415051002",
      "ndc_label_name": "Alternate Site Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70515062830",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515062930",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515063030",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187000545",
      "ndc_label_name": "Altreno Lotion 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224016212",
      "ndc_label_name": "Alum Sulfate-Ca Acetate PACKET EXTERNAL",
      "drug_tier": "Tier 3",
      "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": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63020018030",
      "ndc_label_name": "Alunbrig TABLET 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63020011330",
      "ndc_label_name": "Alunbrig TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63020009007",
      "ndc_label_name": "Alunbrig TABLET 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63020009030",
      "ndc_label_name": "Alunbrig TABLET 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63020019830",
      "ndc_label_name": "Alunbrig Tablet Therapy Pack 90 & 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071201",
      "ndc_label_name": "Alvesco Aerosol Solution 160 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071101",
      "ndc_label_name": "Alvesco Aerosol Solution 80 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039429",
      "ndc_label_name": "Alyacen 1/35 TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093333406",
      "ndc_label_name": "Alyq Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180082913",
      "ndc_label_name": "Amabelz TABLET 0.5-0.1 MG ORAL",
      "drug_tier": "Tier 2",
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180083013",
      "ndc_label_name": "Amabelz TABLET 1-0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180083011",
      "ndc_label_name": "Amabelz TABLET 1-0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591493001",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382051201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781204801",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832101550",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049305",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014220",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014230",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591493005",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155036201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084061101",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663006",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832101500",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155036205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006915",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079024720",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024631",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382051205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781204805",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663061",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049301",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006911",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024671",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084061111",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097092607",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121064610",
      "ndc_label_name": "Amantadine HCl SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080712",
      "ndc_label_name": "Amantadine HCl SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432009316",
      "ndc_label_name": "Amantadine HCl SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121064616",
      "ndc_label_name": "Amantadine HCl SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080716",
      "ndc_label_name": "Amantadine HCl SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049701",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097092512",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097092507",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011150",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492001",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011100",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049705",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746069901",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492005",
      "ndc_label_name": "Amantadine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00039022110",
      "ndc_label_name": "Amaryl TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00039022210",
      "ndc_label_name": "Amaryl TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00039022310",
      "ndc_label_name": "Amaryl TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024552131",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024550131",
      "ndc_label_name": "Ambien CR Tablet Extended Release 6.25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024542131",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024540131",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427193",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038702",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023783",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035411",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035462",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005208",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240630",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710118003",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038602",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005108",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710117903",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035311",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427093",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240530",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035362",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023683",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027815",
      "ndc_label_name": "Amcinonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027830",
      "ndc_label_name": "Amcinonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027860",
      "ndc_label_name": "Amcinonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168028060",
      "ndc_label_name": "Amcinonide LOTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173056100",
      "ndc_label_name": "Amerge TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173056200",
      "ndc_label_name": "Amerge TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862004501",
      "ndc_label_name": "Amethia Lo TABLET 0.1-0.02 & 0.01 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862004591",
      "ndc_label_name": "Amethia Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862004701",
      "ndc_label_name": "Amethia TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52544029528",
      "ndc_label_name": "Amethyst TABLET 90-20 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49411005208",
      "ndc_label_name": "Amicar Solution 0.25 GM/ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49411005030",
      "ndc_label_name": "Amicar Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335058142",
      "ndc_label_name": "Amifostine SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335058140",
      "ndc_label_name": "Amifostine SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011701",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011710",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007111",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980015101",
      "ndc_label_name": "AMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007115",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574029201",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "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": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478076830",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011530",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405506",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084301",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030703",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862015430",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024030",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073205",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037111",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904655661",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084401",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037101",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402504",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024105",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073260",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014405",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014460",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024160",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739038710",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014409",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084402",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022705",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022714",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764024060",
      "ndc_label_name": "Amitiza CAPSULE 24 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64764008060",
      "ndc_label_name": "Amitiza CAPSULE 8 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148610",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017101",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013101",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013120",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068718",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378261001",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044602",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068788",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221221",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017117",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378261010",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221232",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017501",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221621",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079056301",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378268501",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069088",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079056320",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378269501",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017601",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710123001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221721",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069188",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020161",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068888",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122600",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378262510",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221332",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044702",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378262501",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148710",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017201",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017217",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079010720",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221321",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068818",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378265010",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148810",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378265001",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013320",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068988",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221432",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017301",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079013301",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068918",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122700",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221421",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020261",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044802",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017317",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014720",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378267501",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079014701",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221521",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069288",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017401",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093737301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737310",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093767101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737110",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591375905",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093737210",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093767001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378521005",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024319",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005718",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762154002",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019910",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012316",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051654",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005709",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045220",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716898",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342001610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008515",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045201",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762154001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005713",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762154003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739063110",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023910",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378521077",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008511",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005799",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014806",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637161",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027411",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005599",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012116",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636961",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762152001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005513",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008315",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378520805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024110",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762152002",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028511",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180071909",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378520877",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024119",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008311",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762153002",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026301",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637061",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024219",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342001510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005699",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012216",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378520977",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008411",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045101",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378520905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008415",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180072003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014706",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005618",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051554",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024210",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045120",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005613",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762153001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762153003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762153004",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026311",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172293",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673001",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451793",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598032130",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598032190",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673107",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031830",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451893",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031890",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673101",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451993",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673201",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673207",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031590",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031530",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378452093",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031330",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762673301",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762671001",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032330",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451093",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671101",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451193",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032030",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451293",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031730",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671201",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451393",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762672001",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598032230",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598032290",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031990",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451493",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762672101",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031930",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762672207",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031690",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762672201",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031630",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451593",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378451693",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762672301",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598031430",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050030",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702956",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702998",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023630",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458403",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077399",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050090",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031290",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008503",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008509",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077383",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085630",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031230",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019207",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019210",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093703098",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023830",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019307",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019310",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050230",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077583",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077599",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458503",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093703056",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031190",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008603",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031130",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008609",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085730",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008309",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023530",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077299",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019010",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019007",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702756",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008303",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077283",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049930",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049990",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702798",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032490",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458203",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021230",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702856",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031390",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077483",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664077499",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050130",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031330",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023730",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050190",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093702898",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008409",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019110",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505458303",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241008403",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019107",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332021330",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077209",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032730",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017409",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017411",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077206",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077409",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032830",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884018511",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077406",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884018509",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017509",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032530",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017511",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077509",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083830",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ Tablet 10-320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077506",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 10-320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017209",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017211",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032630",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083430",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ Tablet 5-160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077109",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077106",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017311",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017309",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668032930",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077309",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077306",
      "ndc_label_name": "Amlodipine-Valsartan-HCTZ TABLET 5-160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130104",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802049383",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130100",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63044040420",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802049326",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802041954",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63044048409",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672130005",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130009",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802041926",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661185",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661193",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661285",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661293",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661493",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661485",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571501",
      "ndc_label_name": "Amoxapine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571630",
      "ndc_label_name": "Amoxapine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571301",
      "ndc_label_name": "Amoxapine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571401",
      "ndc_label_name": "Amoxapine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781405442",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000114",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781405432",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310701",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029802",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993801",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029801",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202076",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001605",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70882011330",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993805",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310705",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261301",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003105",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001705",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76439010410",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310953",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261305",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993901",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029904",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70882011420",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029902",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029903",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261376",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15749082510",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003101",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415080",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415079",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415073",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506001",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001401",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506020",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002801",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226301",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506101",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002920",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226401",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002901",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001501",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226701",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226801",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598022040",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598022028",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598020451",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598020452",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598020453",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227234",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET CHEWABLE 400-57 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238156401",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536005910",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238156301",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536005710",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185084201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097202",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064308",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013210",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077602",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064408",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077702",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013410",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064508",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185085301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097302",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013510",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064608",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185086401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781018001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064708",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097402",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013610",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097102",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064108",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185083101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013010",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806033901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077502",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064208",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378454201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64720013110",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781214501",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781214505",
      "ndc_label_name": "Ampicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10144042760",
      "ndc_label_name": "Ampyra Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459070060",
      "ndc_label_name": "Amrix Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63459070160",
      "ndc_label_name": "Amrix Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68220005510",
      "ndc_label_name": "Anadrol-50 TABLET 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990603",
      "ndc_label_name": "Anafranil CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990703",
      "ndc_label_name": "Anafranil CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990803",
      "ndc_label_name": "Anafranil CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015504",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003515",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991062010",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093753656",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011221",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756025083",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904619546",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571042103",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505298503",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756025013",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015508",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020910",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003510",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003516",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991062033",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011211",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020906",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187355410",
      "ndc_label_name": "Ancobon CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187355510",
      "ndc_label_name": "Ancobon CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69853010101",
      "ndc_label_name": "Andexxa Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69853010201",
      "ndc_label_name": "Andexxa Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52544007654",
      "ndc_label_name": "Androderm Patch 24 Hour 2 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023599060",
      "ndc_label_name": "Androderm Patch 24 Hour 2 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023599002",
      "ndc_label_name": "Androderm Patch 24 Hour 2 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52544007754",
      "ndc_label_name": "Androderm Patch 24 Hour 4 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023599204",
      "ndc_label_name": "Androderm Patch 24 Hour 4 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023599230",
      "ndc_label_name": "Androderm Patch 24 Hour 4 MG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051846231",
      "ndc_label_name": "AndroGel Gel 20.25 MG/1.25GM (1.62%) Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051846212",
      "ndc_label_name": "AndroGel Gel 20.25 MG/1.25GM (1.62%) Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051842501",
      "ndc_label_name": "AndroGel GEL 25 MG/2.5GM (1%) TRANSDERMAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051842530",
      "ndc_label_name": "AndroGel GEL 25 MG/2.5GM (1%) TRANSDERMAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051846201",
      "ndc_label_name": "AndroGel Gel 40.5 MG/2.5GM (1.62%) Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051846230",
      "ndc_label_name": "AndroGel Gel 40.5 MG/2.5GM (1.62%) Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051845001",
      "ndc_label_name": "AndroGel GEL 50 MG/5GM (1%) TRANSDERMAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051845030",
      "ndc_label_name": "AndroGel GEL 50 MG/5GM (1%) TRANSDERMAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00051846233",
      "ndc_label_name": "AndroGel Pump Gel 20.25 MG/ACT (1.62%) Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187090201",
      "ndc_label_name": "Android Capsule 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58177067126",
      "ndc_label_name": "Anemagen Forte TABLET 50-101-1 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58177067226",
      "ndc_label_name": "Anemagen TABLET 70 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419048203",
      "ndc_label_name": "Angeliq TABLET 0.25-0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419048201",
      "ndc_label_name": "Angeliq TABLET 0.25-0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419048301",
      "ndc_label_name": "Angeliq TABLET 0.5-1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419048303",
      "ndc_label_name": "Angeliq TABLET 0.5-1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173086906",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "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/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51285052302",
      "ndc_label_name": "Antabuse TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51285052402",
      "ndc_label_name": "Antabuse TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00113058840",
      "ndc_label_name": "Antacid Anti-Gas Max Strength SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800017980",
      "ndc_label_name": "Antacid Calcium Extra Strength TABLET CHEWABLE 750 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105022",
      "ndc_label_name": "Antacid Calcium Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113048980",
      "ndc_label_name": "Antacid Extra Strength TABLET CHEWABLE 750 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205020580",
      "ndc_label_name": "Antacid Extra Strength TABLET CHEWABLE 750 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205070680",
      "ndc_label_name": "Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000046001",
      "ndc_label_name": "Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113046880",
      "ndc_label_name": "Antacid Extra Strength TABLET CHEWABLE 750 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205053040",
      "ndc_label_name": "Antacid Fast Acting Suspension 200-200-20 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800085140",
      "ndc_label_name": "Antacid Fast Relief SUSPENSION 200-200-20 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800058840",
      "ndc_label_name": "Antacid Maximum Strength SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205053640",
      "ndc_label_name": "Antacid Maximum Strength Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205053540",
      "ndc_label_name": "Antacid Maximum Strength SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042201",
      "ndc_label_name": "Antacid Maximum Strength Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800035740",
      "ndc_label_name": "Antacid Plus Anti-Gas Fast Act SUSPENSION 200-200-20 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113035740",
      "ndc_label_name": "Antacid Plus Anti-Gas Relief SUSPENSION 200-200-20 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113034040",
      "ndc_label_name": "Antacid Plus Anti-Gas Relief SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113085140",
      "ndc_label_name": "Antacid SUSPENSION 200-200-20 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205031440",
      "ndc_label_name": "Antacid SUSPENSION 200-200-20 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000045901",
      "ndc_label_name": "Antacid Ultra Strength Tablet Chewable 1000 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "27437010706",
      "ndc_label_name": "Antara CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27437010806",
      "ndc_label_name": "Antara CAPSULE 90 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536199553",
      "ndc_label_name": "Anti-Dandruff SHAMPOO 1 % EXTERNAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023001",
      "ndc_label_name": "Anti-Diarrheal Capsule 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800052024",
      "ndc_label_name": "Anti-Diarrheal Capsule 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800052012",
      "ndc_label_name": "Anti-Diarrheal Capsule 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000046101",
      "ndc_label_name": "Anti-Diarrheal Capsule 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113022462",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113022489",
      "ndc_label_name": "Anti-Diarrheal Tablet 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904772512",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800022480",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205037053",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205037089",
      "ndc_label_name": "Anti-Diarrheal Tablet 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113022453",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800022453",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800022462",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205037067",
      "ndc_label_name": "Anti-Diarrheal Tablet 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113022491",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800022491",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904772524",
      "ndc_label_name": "Anti-Diarrheal TABLET 2 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51660012312",
      "ndc_label_name": "Anti-Diarrheal Tablet 2 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536515026",
      "ndc_label_name": "Anti-Fungal POWDER 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113097364",
      "ndc_label_name": "Anti-Itch Maximum Strength CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113054164",
      "ndc_label_name": "Anti-Itch Maximum Strength CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055798",
      "ndc_label_name": "Anti-Oxidant TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08330137201",
      "ndc_label_name": "Anti-Stick Tuberculin Syringe 25G X 5/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904072236",
      "ndc_label_name": "Antifungal CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205019710",
      "ndc_label_name": "Antifungal Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472073556",
      "ndc_label_name": "Antifungal CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472073542",
      "ndc_label_name": "Antifungal CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472073514",
      "ndc_label_name": "Antifungal CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000032301",
      "ndc_label_name": "Antifungal POWDER 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629093606",
      "ndc_label_name": "Antioxidant A/C/E/Selenium TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629077660",
      "ndc_label_name": "Antioxidant CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536558806",
      "ndc_label_name": "Antioxidant Formula CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536103706",
      "ndc_label_name": "Antioxidant Formula TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904504452",
      "ndc_label_name": "Antioxidant TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614032372",
      "ndc_label_name": "Antioxidant Vitamins TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30698012105",
      "ndc_label_name": "Anzemet TABLET 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "30698012005",
      "ndc_label_name": "Anzemet TABLET 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42195084010",
      "ndc_label_name": "APAP-Caff-Dihydrocodeine Capsule 320.5-30-16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00482001608",
      "ndc_label_name": "Apatate Forte Liquid Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10337039560",
      "ndc_label_name": "ApexiCon E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10337039530",
      "ndc_label_name": "ApexiCon E CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250205",
      "ndc_label_name": "Apidra SoloStar Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250033",
      "ndc_label_name": "Apidra SOLUTION 100 UNIT/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187581030",
      "ndc_label_name": "Aplenzin Tablet Extended Release 24 Hour 174 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187581130",
      "ndc_label_name": "Aplenzin Tablet Extended Release 24 Hour 348 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187581230",
      "ndc_label_name": "Aplenzin Tablet Extended Release 24 Hour 522 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "18407063105",
      "ndc_label_name": "Aplicare Alcohol Swabstick Pad 70 %",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "27505000405",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27505000401",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071611",
      "ndc_label_name": "Apraclonidine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071610",
      "ndc_label_name": "Apraclonidine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314066505",
      "ndc_label_name": "Apraclonidine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314066510",
      "ndc_label_name": "Apraclonidine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232368",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058540",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058576",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232151",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232106",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058340",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058385",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781406336",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462011233",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232268",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058476",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058440",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232246",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462058458",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555904358",
      "ndc_label_name": "Apri TABLET 0.15-30 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65649010302",
      "ndc_label_name": "Apriso Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040145",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040245",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040345",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040445",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040545",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040645",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040745",
      "ndc_label_name": "Aptensio XR CAPSULE EXTENDED RELEASE 24 HOUR 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020230",
      "ndc_label_name": "Aptiom TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020430",
      "ndc_label_name": "Aptiom TABLET 400 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020660",
      "ndc_label_name": "Aptiom TABLET 600 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020830",
      "ndc_label_name": "Aptiom TABLET 800 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597000302",
      "ndc_label_name": "Aptivus CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597000201",
      "ndc_label_name": "Aptivus SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38415051208",
      "ndc_label_name": "Aqua Lance Adjustable Lancing DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58914001106",
      "ndc_label_name": "AquADEKs CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58914001460",
      "ndc_label_name": "AquADEKs TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60913000101",
      "ndc_label_name": "AquaLance Lancets 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00944281501",
      "ndc_label_name": "Aralast NP SOLUTION RECONSTITUTED 1000 MG Intravenous",
      "drug_tier": "Tier 4",
      "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": "Tier 4",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000504",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000501",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000601",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 200 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000204",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000201",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513011001",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 300 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000304",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 40 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000301",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 40 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000404",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000401",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513009801",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 10 MCG/0.4ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513009804",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 10 MCG/0.4ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002504",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002501",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002701",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 150 MCG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002704",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 150 MCG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002801",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 200 MCG/0.4ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005701",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005704",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513011101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 300 MCG/0.6ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002104",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513003201",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 500 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002304",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002301",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088216030",
      "ndc_label_name": "Arava TABLET 10 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088216130",
      "ndc_label_name": "Arava TABLET 20 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000101",
      "ndc_label_name": "Arcalyst SOLUTION RECONSTITUTED 220 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402067501",
      "ndc_label_name": "Arcapta Neohaler Capsule 75 MCG Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402067530",
      "ndc_label_name": "Arcapta Neohaler CAPSULE 75 MCG Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "89076021786",
      "ndc_label_name": "Arial Chamber DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62856024630",
      "ndc_label_name": "Aricept TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856024730",
      "ndc_label_name": "Aricept TABLET 23 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856024530",
      "ndc_label_name": "Aricept TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71558059028",
      "ndc_label_name": "Arikayce Suspension 590 MG/8.4ML Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559067030",
      "ndc_label_name": "Arimidex Tablet 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089374",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651011055",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838057059",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505040405",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021805",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021890",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089803",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066305",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066330",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028010",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005308",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267408",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028001",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012407",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093758056",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021830",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005303",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082730",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008915",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017901",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009930",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089809",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651161",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078501",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009931",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005403",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005408",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009011",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093758156",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028110",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082830",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019121",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010031",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089903",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021930",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021990",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028101",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010030",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066405",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066430",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651204",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021905",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012507",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009012",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267508",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019111",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089909",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021630",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005103",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005108",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089603",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066130",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012207",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015721",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066105",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081930",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009731",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004430",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650904",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021605",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030203",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055430",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307503",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307508",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089609",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093761356",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027801",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008712",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021690",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027810",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009730",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028201",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005508",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090109",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093758256",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267608",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020221",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090103",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009111",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009112",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020211",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651304",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022030",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010131",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066505",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022090",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005503",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082930",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010130",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066530",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022005",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028210",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012607",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022130",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010231",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028301",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021321",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090203",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066605",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022105",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028310",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005603",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055930",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009211",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267708",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021311",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010230",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004930",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093758356",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078801",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651404",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022190",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012707",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005608",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083030",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009212",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090209",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066630",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651006",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904665640",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021790",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016801",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041310",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066230",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093756956",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005203",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267308",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009831",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089709",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651061",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078401",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027901",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005208",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027910",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012307",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008815",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089703",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021730",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082030",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021705",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009830",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066205",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040003",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010330",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073330",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010430",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040103",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073430",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757050003",
      "ndc_label_name": "Aristada Initio Prefilled Syringe 675 MG/2.4ML Intramuscular",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040401",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457059500",
      "ndc_label_name": "Arixtra SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059508",
      "ndc_label_name": "Arixtra SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059210",
      "ndc_label_name": "Arixtra SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059200",
      "ndc_label_name": "Arixtra SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059304",
      "ndc_label_name": "Arixtra SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059300",
      "ndc_label_name": "Arixtra SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059400",
      "ndc_label_name": "Arixtra SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059406",
      "ndc_label_name": "Arixtra SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378343293",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803731",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080630",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309256",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057102",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057107",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804531",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651004730",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057202",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309356",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057207",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080730",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343393",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057307",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805331",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309456",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180057302",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309056",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343193",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080530",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781802931",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180056907",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310072206",
      "ndc_label_name": "ArmonAir RespiClick 232 Aerosol Powder Breath Activated 232 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310070506",
      "ndc_label_name": "ArmonAir RespiClick 55 Aerosol Powder Breath Activated 55 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456046101",
      "ndc_label_name": "Armour Thyroid TABLET 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045701",
      "ndc_label_name": "Armour Thyroid TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046201",
      "ndc_label_name": "Armour Thyroid TABLET 180 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046301",
      "ndc_label_name": "Armour Thyroid TABLET 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045801",
      "ndc_label_name": "Armour Thyroid TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046401",
      "ndc_label_name": "Armour Thyroid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045901",
      "ndc_label_name": "Armour Thyroid TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046001",
      "ndc_label_name": "Armour Thyroid TABLET 90 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087414",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 100 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "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": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00009766304",
      "ndc_label_name": "Aromasin TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323063710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918072010",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742043810",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789060010",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099701",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323063703",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918072001",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51660033350",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800054471",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800096647",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800054478",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800054462",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660033301",
      "ndc_label_name": "Arthritis Pain Relief Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536111825",
      "ndc_label_name": "Arthritis Pain Relieving CREAM 0.075 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00025141160",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 50-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00025141190",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 50-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00025142160",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 75-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536108494",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478006012",
      "ndc_label_name": "Artificial Tears SOLUTION 1.4 % OPHTHALMIC",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69344011111",
      "ndc_label_name": "Arymo ER Tablet Extended Release Abuse-Deterrent 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69344021111",
      "ndc_label_name": "Arymo ER Tablet Extended Release Abuse-Deterrent 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69344031111",
      "ndc_label_name": "Arymo ER Tablet Extended Release Abuse-Deterrent 60 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078066961",
      "ndc_label_name": "Arzerra CONCENTRATE 100 MG/5ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078066913",
      "ndc_label_name": "Arzerra CONCENTRATE 100 MG/5ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078069061",
      "ndc_label_name": "Arzerra CONCENTRATE 1000 MG/50ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023590118",
      "ndc_label_name": "Asacol HD Tablet Delayed Release 800 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00193364201",
      "ndc_label_name": "Ascensia Autodisc Control Liquid Normal In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193364302",
      "ndc_label_name": "Ascensia Autodisc Controls Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193397201",
      "ndc_label_name": "Ascensia Elite Control LIQUID† Normal IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193394002",
      "ndc_label_name": "Ascensia Elite Controls LIQUID† IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11694071901",
      "ndc_label_name": "Asco-Tabs-1000 TABLET 1000 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51991007405",
      "ndc_label_name": "Ascomp-Codeine CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991007401",
      "ndc_label_name": "Ascomp-Codeine CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135014101",
      "ndc_label_name": "Ascorbic Acid TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014110",
      "ndc_label_name": "Ascorbic Acid TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "23629000410",
      "ndc_label_name": "Ascorbic Acid TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135016513",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014205",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001510",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014203",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014210",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014260",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014201",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "23490688801",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "23490688806",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014269",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68462064693",
      "ndc_label_name": "Ashlyna TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "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": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085134101",
      "ndc_label_name": "Asmanex (120 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085134106",
      "ndc_label_name": "Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085146102",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 110 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085134107",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085134102",
      "ndc_label_name": "Asmanex (60 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085433301",
      "ndc_label_name": "Asmanex HFA Aerosol 100 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085433401",
      "ndc_label_name": "Asmanex HFA Aerosol 200 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904770470",
      "ndc_label_name": "Aspir-Low Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904770480",
      "ndc_label_name": "Aspir-Low Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904770418",
      "ndc_label_name": "Aspir-Low TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62107002726",
      "ndc_label_name": "Aspirin 81 Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62107002732",
      "ndc_label_name": "Aspirin 81 Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800002712",
      "ndc_label_name": "Aspirin Adult Low Dose TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800025968",
      "ndc_label_name": "Aspirin Adult Low Strength TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904680940",
      "ndc_label_name": "Aspirin Adult Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674460",
      "ndc_label_name": "Aspirin Adult Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00603002622",
      "ndc_label_name": "Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00603002632",
      "ndc_label_name": "Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800027748",
      "ndc_label_name": "Aspirin EC Low Strength Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00603016921",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904201380",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035711",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800042902",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536331301",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904201360",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904201372",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483033101",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023701",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000035901",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00603016932",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904671260",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739052301",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023702",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904201159",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483033110",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536331310",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68084084825",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68084084895",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536114801",
      "ndc_label_name": "Aspirin EC Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035708",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739052201",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739052210",
      "ndc_label_name": "Aspirin EC TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000010201",
      "ndc_label_name": "Aspirin Low Dose Adult Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000010303",
      "ndc_label_name": "Aspirin Low Dose Adult Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000010301",
      "ndc_label_name": "Aspirin Low Dose Adult Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904628889",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483033463",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904628880",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800046768",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800027468",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904679489",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904679480",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483048112",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483048110",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042801",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904675180",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904671318",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904678370",
      "ndc_label_name": "Aspirin Low Dose Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483038710",
      "ndc_label_name": "Aspirin Low Dose TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483038712",
      "ndc_label_name": "Aspirin Low Dose TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739043401",
      "ndc_label_name": "Aspirin Low Strength TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000020203",
      "ndc_label_name": "Aspirin Regimen Low Dose Adult Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000020202",
      "ndc_label_name": "Aspirin Regimen Low Dose Adult Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574703412",
      "ndc_label_name": "Aspirin SUPPOSITORY 300 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00574703612",
      "ndc_label_name": "Aspirin SUPPOSITORY 600 MG Rectal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904681180",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645071601",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025303",
      "ndc_label_name": "Aspirin TABLET 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105301",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105305",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105429",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536330501",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51645071610",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103036511",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103036508",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536330510",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37205066887",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483001110",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025301",
      "ndc_label_name": "Aspirin TABLET 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025302",
      "ndc_label_name": "Aspirin TABLET 325 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536100862",
      "ndc_label_name": "Aspirin Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103036605",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000041901",
      "ndc_label_name": "Aspirin Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904404073",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042001",
      "ndc_label_name": "Aspirin Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103036611",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00603002436",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100836",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000017001",
      "ndc_label_name": "Aspirin TABLET CHEWABLE 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042002",
      "ndc_label_name": "Aspirin Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035611",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100410",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536100441",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536114941",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035609",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800003018",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70882012230",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43598033960",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436009205",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030532",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030533",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162059606",
      "ndc_label_name": "Aspirin-Dipyridamole ER CAPSULE EXTENDED RELEASE 12 HOUR 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093306406",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714096401",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884000702",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373071800",
      "ndc_label_name": "Assess Full Range Peak Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373071000",
      "ndc_label_name": "Assess Full Range Peak Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373071900",
      "ndc_label_name": "Assess Low Range Peak Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373075000",
      "ndc_label_name": "Assess Low Range Peak Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50486008415",
      "ndc_label_name": "Assess Peak Flow Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50486008410",
      "ndc_label_name": "Assess Peak Flow Meter DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317550602",
      "ndc_label_name": "Assure 3 Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317560006",
      "ndc_label_name": "Assure 4 Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317560100",
      "ndc_label_name": "Assure 4 Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317560050",
      "ndc_label_name": "Assure 4 Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000201",
      "ndc_label_name": "Assure Comfort Lancets 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500005",
      "ndc_label_name": "Assure Dose Control SOLUTION Normal IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500006",
      "ndc_label_name": "Assure Dose Norm/High Control SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317970118",
      "ndc_label_name": "Assure Haemolance Plus High",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317970125",
      "ndc_label_name": "Assure Haemolance Plus Low",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317970128",
      "ndc_label_name": "Assure Haemolance Plus Micro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317970121",
      "ndc_label_name": "Assure Haemolance Plus Normal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317970112",
      "ndc_label_name": "Assure Haemolance Plus Ped",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317220602",
      "ndc_label_name": "Assure II Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317220501",
      "ndc_label_name": "Assure II Control Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980225",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980125",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980128",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980228",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980121",
      "ndc_label_name": "Assure Lance Lancets 21G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990125",
      "ndc_label_name": "Assure Lance Plus Safety 25G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990130",
      "ndc_label_name": "Assure Lance Plus Safety 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980328",
      "ndc_label_name": "Assure Lance Safety Lancet 28G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38415010029",
      "ndc_label_name": "Assure Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500001",
      "ndc_label_name": "Assure Platinum Meter DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500050",
      "ndc_label_name": "Assure Platinum STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500100",
      "ndc_label_name": "Assure Platinum STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530006",
      "ndc_label_name": "Assure Prism Control Level 1&2 SOLUTION IN VITRO",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530001",
      "ndc_label_name": "Assure Prism multi Meter DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530101",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317532050",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530050",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317460006",
      "ndc_label_name": "Assure Pro Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00469064773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469067773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469068773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00037024330",
      "ndc_label_name": "Astepro SOLUTION 0.15 % NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373074000",
      "ndc_label_name": "Asthma Check Meter-Zone System DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373074200",
      "ndc_label_name": "AsthmaMentOr DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08238115301",
      "ndc_label_name": "At Last Control SOLUTION In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08238053904",
      "ndc_label_name": "At Last Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62559065090",
      "ndc_label_name": "Atacand HCT Tablet 16-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186016254",
      "ndc_label_name": "Atacand HCT Tablet 16-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186032254",
      "ndc_label_name": "Atacand HCT Tablet 32-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559065190",
      "ndc_label_name": "Atacand HCT Tablet 32-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559065290",
      "ndc_label_name": "Atacand HCT Tablet 32-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186032454",
      "ndc_label_name": "Atacand HCT Tablet 32-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064290",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186001654",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186001631",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064230",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186003254",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064390",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186003231",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064330",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186000431",
      "ndc_label_name": "Atacand Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064030",
      "ndc_label_name": "Atacand Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186000831",
      "ndc_label_name": "Atacand Tablet 8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559064130",
      "ndc_label_name": "Atacand Tablet 8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093552606",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097044403",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862071160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762040806",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093552706",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714086101",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762040906",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862071260",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097044503",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039925",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862071330",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039995",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762041003",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097044602",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093552856",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00430097903",
      "ndc_label_name": "Atelvia TABLET DELAYED RELEASE 35 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075305",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002410",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068501",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068520",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002401",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043901",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150710",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043910",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075710",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075701",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150701",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062310",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002210",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078701",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781107801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043701",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021810",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043710",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002201",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062101",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781107810",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075901",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075920",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062110",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023101",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150610",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023110",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043801",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002310",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645049354",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068401",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043810",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002301",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781150601",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068420",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645058554",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009722402",
      "ndc_label_name": "Atgam INJECTABLE 50 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009722401",
      "ndc_label_name": "Atgam INJECTABLE 50 MG/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "37205094199",
      "ndc_label_name": "Athletes Foot AF CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000032201",
      "ndc_label_name": "Athletes Foot Powder Spray Aerosol Powder 1 % External",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113015473",
      "ndc_label_name": "Athletes Foot Spray Aerosol 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00187006301",
      "ndc_label_name": "Ativan TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187006401",
      "ndc_label_name": "Ativan TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187006410",
      "ndc_label_name": "Ativan TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187006501",
      "ndc_label_name": "Ativan TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "26893010192",
      "ndc_label_name": "Atlas Color Condom/Spermicide DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "26893010102",
      "ndc_label_name": "Atlas Color Lubricated Condom DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "26893010092",
      "ndc_label_name": "Atlas Lub Condom/Spermicide DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "26893010002",
      "ndc_label_name": "Atlas Lubricated Condom DEVICE",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111051930",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037303",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026530",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354256",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283003",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004030",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075501",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027130",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354856",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076101",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056430",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004630",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283603",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037903",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075601",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354356",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283103",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052030",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037403",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004130",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026630",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004230",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026730",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075701",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037503",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354456",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052830",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283203",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354556",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032695",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075801",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283303",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037603",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032625",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690804",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004330",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052130",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026830",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075901",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283403",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037703",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026930",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354656",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052230",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004430",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037803",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056330",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354756",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004530",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027030",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076001",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283503",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505698",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395005",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004417",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020820",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012190",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089046",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045854",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395007",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395077",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009315",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015501",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257809",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089043",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009711",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629061",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009311",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048054",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538192",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015502",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257808",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094415",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009415",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012290",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015602",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048154",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048254",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089143",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395177",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538292",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004517",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094512",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629161",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015601",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089146",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009811",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009411",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257909",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094505",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505998",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395107",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020920",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257908",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045954",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395277",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009511",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395207",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009515",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021001",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021020",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258008",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056854",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629261",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458088116",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089241",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009911",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258009",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048354",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004617",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012390",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089246",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645046054",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094605",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094615",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505898",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538492",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015702",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505798",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395377",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004716",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015802",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089741",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059095",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089746",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094705",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538892",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009612",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012490",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267108",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645046154",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377003012",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009611",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645049554",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094712",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395307",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629304",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059025",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993006272",
      "ndc_label_name": "Atovaquone SUSPENSION 750 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462042121",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028201",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689006242",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722062921",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162069388",
      "ndc_label_name": "Atovaquone SUSPENSION 750 MG/5ML ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689006218",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024514",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040444",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040401",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040467",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378416201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993006002",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993006027",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024500",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024515",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378416001",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13548007045",
      "ndc_label_name": "Atralin GEL 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15584010101",
      "ndc_label_name": "Atripla TABLET 600-200-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478021502",
      "ndc_label_name": "Atropine Sulfate SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021515",
      "ndc_label_name": "Atropine Sulfate SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021505",
      "ndc_label_name": "Atropine Sulfate SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 3",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021002",
      "ndc_label_name": "Aubagio TABLET 14 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021101",
      "ndc_label_name": "Aubagio TABLET 7 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50102022023",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102022021",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012048",
      "ndc_label_name": "Aubra TABLET 0.1-20 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012010",
      "ndc_label_name": "Aubra TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012003",
      "ndc_label_name": "Aubra TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012001",
      "ndc_label_name": "Aubra TABLET 0.1-20 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598001251",
      "ndc_label_name": "Augmentin Suspension Reconstituted 125-31.25 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598001252",
      "ndc_label_name": "Augmentin Suspension Reconstituted 125-31.25 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598001253",
      "ndc_label_name": "Augmentin Suspension Reconstituted 125-31.25 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000451",
      "ndc_label_name": "Augmentin Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000452",
      "ndc_label_name": "Augmentin Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000453",
      "ndc_label_name": "Augmentin Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598002028",
      "ndc_label_name": "Augmentin XR Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598002040",
      "ndc_label_name": "Augmentin XR Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "32671020144",
      "ndc_label_name": "Aurora Healthcare Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214065724",
      "ndc_label_name": "Aurora Lancet Super Thin 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214015724",
      "ndc_label_name": "Aurora Lancet Thin 23G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59922063101",
      "ndc_label_name": "Auryxia TABLET 1 GM 210 MG(Fe) ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546017260",
      "ndc_label_name": "Austedo TABLET 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546017060",
      "ndc_label_name": "Austedo TABLET 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546017160",
      "ndc_label_name": "Austedo TABLET 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25294000602",
      "ndc_label_name": "Auto-Lancet",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000616",
      "ndc_label_name": "Auto-Lancet",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000601",
      "ndc_label_name": "Auto-Lancet",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000100",
      "ndc_label_name": "Auto-Lancet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000624",
      "ndc_label_name": "Auto-Lancet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000603",
      "ndc_label_name": "Auto-Lancet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000600",
      "ndc_label_name": "Auto-Lancet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294083100",
      "ndc_label_name": "Auto-Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027101",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68016016201",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027001",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027101",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027001",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470026001",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214026001",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214026501",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470026501",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027501",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027601",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027401",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00024585530",
      "ndc_label_name": "Avalide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024585630",
      "ndc_label_name": "Avalide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173086118",
      "ndc_label_name": "Avandia TABLET 2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173086313",
      "ndc_label_name": "Avandia TABLET 4 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024585130",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024585230",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024585090",
      "ndc_label_name": "Avapro TABLET 75 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242006001",
      "ndc_label_name": "Avastin SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242006010",
      "ndc_label_name": "Avastin Solution 100 MG/4ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242006101",
      "ndc_label_name": "Avastin SOLUTION 400 MG/16ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242006110",
      "ndc_label_name": "Avastin Solution 400 MG/16ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00037663104",
      "ndc_label_name": "AVC Vaginal CREAM 15 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67979051143",
      "ndc_label_name": "Aveed SOLUTION 750 MG/3ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419053001",
      "ndc_label_name": "Avelox Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904558",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378614144",
      "ndc_label_name": "Avita CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378614145",
      "ndc_label_name": "Avita CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378614044",
      "ndc_label_name": "Avita GEL 0.025 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378614045",
      "ndc_label_name": "Avita GEL 0.025 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071204",
      "ndc_label_name": "Avodart CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173071215",
      "ndc_label_name": "Avodart CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59627011103",
      "ndc_label_name": "Avonex Kit 30 MCG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59627033304",
      "ndc_label_name": "Avonex Pen Auto-injector Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59627022205",
      "ndc_label_name": "Avonex Prefilled Prefilled Syringe Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51285042410",
      "ndc_label_name": "Aygestin TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00225038080",
      "ndc_label_name": "Ayr SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569342500",
      "ndc_label_name": "Ayr Solution 0.65 % Nasal",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65862084888",
      "ndc_label_name": "Ayuna Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030610",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598046562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067811",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323077139",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009602",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598030562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001031356",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079798",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591289749",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009601",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781325394",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925394",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13925052301",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025430",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097080540",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65649024141",
      "ndc_label_name": "Azasan TABLET 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65649023141",
      "ndc_label_name": "Azasan TABLET 75 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478030703",
      "ndc_label_name": "AzaSite SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000301",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462050201",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219107601",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000305",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022901",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378100501",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079062001",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079062006",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022911",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71258001502",
      "ndc_label_name": "Azedra Dosimetric Solution 15 MCI/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71258001522",
      "ndc_label_name": "Azedra Therapeutic Solution 15 MCI/ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071810",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093890",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057804",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314030802",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054029399",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505083305",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525029403",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081403",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335077991",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525023403",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.15 % NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802002683",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.15 % NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505084805",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.15 % NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162067684",
      "ndc_label_name": "Azelastine HCl SOLUTION 137 MCG/SPRAY Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877047750",
      "ndc_label_name": "Azelastine HCl SOLUTION 137 MCG/SPRAY Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023869450",
      "ndc_label_name": "Azelex CREAM 20 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023869430",
      "ndc_label_name": "Azelex CREAM 20 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546014256",
      "ndc_label_name": "Azilect TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68546022956",
      "ndc_label_name": "Azilect TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762305102",
      "ndc_label_name": "Azithromycin PACKET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305101",
      "ndc_label_name": "Azithromycin PACKET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577631",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078766",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096104",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577626",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505258103",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064163",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577669",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808926",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096105",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016013",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670861",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078751",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762306003",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016006",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016011",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078710",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009811",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010315",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064169",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009815",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010311",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762306001",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096101",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781578931",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078855",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009911",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027111",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016106",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016113",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781578903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078867",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762307002",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010413",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096405",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064264",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010411",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505258203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027121",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096401",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078810",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096403",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009913",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078910",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031425",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096201",
      "ndc_label_name": "Azithromycin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031495",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016206",
      "ndc_label_name": "Azithromycin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781579331",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065027510",
      "ndc_label_name": "Azopt SUSPENSION 1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065027515",
      "ndc_label_name": "Azopt SUSPENSION 1 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597011130",
      "ndc_label_name": "Azor TABLET 10-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597011330",
      "ndc_label_name": "Azor TABLET 10-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597011030",
      "ndc_label_name": "Azor TABLET 5-20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597011230",
      "ndc_label_name": "Azor TABLET 5-40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00013010220",
      "ndc_label_name": "Azulfidine EN-tabs TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010201",
      "ndc_label_name": "Azulfidine EN-tabs TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010120",
      "ndc_label_name": "Azulfidine TABLET 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00013010101",
      "ndc_label_name": "Azulfidine TABLET 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007201",
      "ndc_label_name": "Azurette TABLET 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54629066180",
      "ndc_label_name": "B Complex CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536478701",
      "ndc_label_name": "B Complex CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629066170",
      "ndc_label_name": "B Complex CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845006011",
      "ndc_label_name": "B Complex CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629056301",
      "ndc_label_name": "B Complex Formula 1 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000131",
      "ndc_label_name": "B Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761044820",
      "ndc_label_name": "B Complex Vitamins CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845060101",
      "ndc_label_name": "B Complex Vitamins CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629056001",
      "ndc_label_name": "B Complex Vitamins CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629056102",
      "ndc_label_name": "B Complex Vitamins CAPSULE ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569273900",
      "ndc_label_name": "B Complex Vitamins Plus TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010175",
      "ndc_label_name": "B Complex-C-Folic Acid TABLET Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54868320401",
      "ndc_label_name": "B Complex-Vitamin B12 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005661",
      "ndc_label_name": "B-1 TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001762",
      "ndc_label_name": "B-100 Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000770",
      "ndc_label_name": "B-100 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000772",
      "ndc_label_name": "B-100 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005741",
      "ndc_label_name": "B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135065250",
      "ndc_label_name": "B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135065201",
      "ndc_label_name": "B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135065263",
      "ndc_label_name": "B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010602",
      "ndc_label_name": "B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986002222",
      "ndc_label_name": "B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005731",
      "ndc_label_name": "B-12 TABLET 50 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013971",
      "ndc_label_name": "B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022309",
      "ndc_label_name": "B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007930",
      "ndc_label_name": "B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002731",
      "ndc_label_name": "B-12 Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985021104",
      "ndc_label_name": "B-12 Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131011143",
      "ndc_label_name": "B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312058911",
      "ndc_label_name": "B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027112",
      "ndc_label_name": "B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013964",
      "ndc_label_name": "B-12 TR Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002730",
      "ndc_label_name": "B-12 TR Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013963",
      "ndc_label_name": "B-12 TR Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007932",
      "ndc_label_name": "B-12 TR Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845007141",
      "ndc_label_name": "B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000120",
      "ndc_label_name": "B-2 TABLET 50 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001763",
      "ndc_label_name": "B-50 Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629003610",
      "ndc_label_name": "B-50 Formula TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000580",
      "ndc_label_name": "B-50 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000583",
      "ndc_label_name": "B-50 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007926",
      "ndc_label_name": "B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985021196",
      "ndc_label_name": "B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000124",
      "ndc_label_name": "B-6 TABLET 250 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005701",
      "ndc_label_name": "B-6 TABLET 50 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53191001101",
      "ndc_label_name": "B-Caro-T CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53191001125",
      "ndc_label_name": "B-Caro-T CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007941",
      "ndc_label_name": "B-Complex Balanced TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768000601",
      "ndc_label_name": "B-Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986002071",
      "ndc_label_name": "B-Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004416",
      "ndc_label_name": "B-Complex-C TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006546",
      "ndc_label_name": "B-Complex-C TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000530",
      "ndc_label_name": "B-Complex/Folic Acid/Vitamin C Tablet Extended Release Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013858",
      "ndc_label_name": "B-Complex/Vitamin C TABLET Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013935",
      "ndc_label_name": "B-Complex/Vitamin C TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10267102701",
      "ndc_label_name": "B-Plex Plus TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267102705",
      "ndc_label_name": "B-Plex Plus TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267102505",
      "ndc_label_name": "B-Plex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267102501",
      "ndc_label_name": "B-Plex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "30768003986",
      "ndc_label_name": "B2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742043574",
      "ndc_label_name": "B6 Natural TABLET 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00225055050",
      "ndc_label_name": "Baby Ayr Saline SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001118",
      "ndc_label_name": "Baby Darlings Ped Electrolyte SOLUTION ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001117",
      "ndc_label_name": "Baby Darlings Ped Electrolyte SOLUTION ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001116",
      "ndc_label_name": "Baby Darlings Ped Electrolyte SOLUTION ORAL",
      "drug_tier": "Tier 3",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "37205027510",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00713028031",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006003",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006001",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006070",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574402235",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472110556",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800008902",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672207502",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472110534",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672207501",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904667967",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056220",
      "ndc_label_name": "Baclofen Solution 10 MG/20ML Intrathecal",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056320",
      "ndc_label_name": "Baclofen Solution 20000 MCG/20ML Intrathecal",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056420",
      "ndc_label_name": "Baclofen Solution 40 MG/20ML Intrathecal",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133001",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240632",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647561",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409680",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133010",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240621",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102400",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105415",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007106",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102410",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105411",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007104",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032010",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739047910",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085511",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240628",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085501",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102450",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105410",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128505",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105511",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739048010",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128600",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128605",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409780",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102510",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102550",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105515",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007205",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409760",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832102500",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105510",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647661",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133701",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007204",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032110",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086801",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133705",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240721",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240732",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086811",
      "ndc_label_name": "Baclofen TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240728",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817031910",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00682300101",
      "ndc_label_name": "Bacmin TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708014601",
      "ndc_label_name": "Bactrim DS TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708014501",
      "ndc_label_name": "Bactrim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54629013105",
      "ndc_label_name": "Balance B-100 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629066203",
      "ndc_label_name": "Balance B-100 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629066200",
      "ndc_label_name": "Balance B-50 TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904319251",
      "ndc_label_name": "Balanced B-100 Tablet Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292022311",
      "ndc_label_name": "Balanced B-50 Complex TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904317760",
      "ndc_label_name": "Balanced B-50 Tablet Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75854060203",
      "ndc_label_name": "Balcoltra Tablet 0.1-20 MG-MCG(21) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060228",
      "ndc_label_name": "Balcoltra Tablet 0.1-20 MG-MCG(21) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010213",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010211",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054007928",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257507",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682075002",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676003084",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676003056",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676004028",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676004056",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676005028",
      "ndc_label_name": "Balversa Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555903479",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903458",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904203524",
      "ndc_label_name": "Banophen CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904530624",
      "ndc_label_name": "Banophen Capsule 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904530680",
      "ndc_label_name": "Banophen CAPSULE 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904530660",
      "ndc_label_name": "Banophen CAPSULE 25 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904530760",
      "ndc_label_name": "Banophen CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904530780",
      "ndc_label_name": "Banophen CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904122800",
      "ndc_label_name": "Banophen Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904517416",
      "ndc_label_name": "Banophen Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904555124",
      "ndc_label_name": "Banophen TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904555159",
      "ndc_label_name": "Banophen TABLET 25 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62856058446",
      "ndc_label_name": "Banzel SUSPENSION 40 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856058252",
      "ndc_label_name": "Banzel TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856058352",
      "ndc_label_name": "Banzel TABLET 400 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003161412",
      "ndc_label_name": "Baraclude SOLUTION 0.05 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003161112",
      "ndc_label_name": "Baraclude TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003161212",
      "ndc_label_name": "Baraclude TABLET 1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08011802055",
      "ndc_label_name": "Bardia Bulb Irrigation Syringe 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08011802065",
      "ndc_label_name": "Bardia Piston Irrigation Syr 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35797068726",
      "ndc_label_name": "Bariatric Multivitamins/Iron Capsule Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39713054526",
      "ndc_label_name": "Bariatric Multivitamins/Iron Capsule Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00002771559",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002771501",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087353501",
      "ndc_label_name": "Bavencio SOLUTION 200 MG/10ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010102",
      "ndc_label_name": "Baxdela Tablet 450 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010101",
      "ndc_label_name": "Baxdela TABLET 450 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00193149101",
      "ndc_label_name": "Bayer Breeze 2 Control Liquid High In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193149001",
      "ndc_label_name": "Bayer Breeze 2 Control Liquid Low In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193148901",
      "ndc_label_name": "Bayer Breeze 2 Control Liquid Normal In Vitro",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193967430",
      "ndc_label_name": "Bayer Breeze 2 Test Disk In Vitro",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193616001",
      "ndc_label_name": "Bayer Contour Link Monitor Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193955601",
      "ndc_label_name": "Bayer Contour Monitor Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193660601",
      "ndc_label_name": "Bayer Microlet 2 Lancing Devic",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193654621",
      "ndc_label_name": "Bayer Microlet Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290550003",
      "ndc_label_name": "BD Allergy Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305500",
      "ndc_label_name": "BD Allergy Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290550002",
      "ndc_label_name": "BD Allergy Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290525506",
      "ndc_label_name": "BD Assure BPM/Auto Arm Cuff",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290525508",
      "ndc_label_name": "BD Assure BPM/Auto Wrist Cuff",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290525507",
      "ndc_label_name": "BD Assure BPM/Deluxe Arm Cuff",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290525505",
      "ndc_label_name": "BD Assure BPM/Manual Arm Cuff",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290525509",
      "ndc_label_name": "BD Assure BPM/Port Wristwatch",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290329515",
      "ndc_label_name": "BD AutoShield Duo 30G X 5 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305789",
      "ndc_label_name": "BD Eclipse Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366583",
      "ndc_label_name": "BD Genie",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366579",
      "ndc_label_name": "BD Genie Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290326730",
      "ndc_label_name": "BD Insulin Syringe U-500 31G X 6MM 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290328440",
      "ndc_label_name": "BD Insulin Syringe U/F 1/2Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328431",
      "ndc_label_name": "BD Insulin Syringe U/F 30G X 1/2\" 0.3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328466",
      "ndc_label_name": "BD Insulin Syringe U/F 30G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328411",
      "ndc_label_name": "BD Insulin Syringe U/F 30G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328438",
      "ndc_label_name": "BD Insulin Syringe U/F 31G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328468",
      "ndc_label_name": "BD Insulin Syringe U/F 31G X 5/16\" 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328418",
      "ndc_label_name": "BD Insulin Syringe U/F 31G X 5/16\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290511403",
      "ndc_label_name": "BD Klatskin Biopsy Needle 16G X 4\"",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290325775",
      "ndc_label_name": "BD Lancet Device",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290325772",
      "ndc_label_name": "BD Lancet Ultrafine 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290325773",
      "ndc_label_name": "BD Lancet Ultrafine 30G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290322057",
      "ndc_label_name": "BD Lancet Ultrafine 33G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290322065",
      "ndc_label_name": "BD Lancet Ultrafine 33G",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305062",
      "ndc_label_name": "BD Luer-Lock Syringe 18G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309644",
      "ndc_label_name": "BD Luer-Lok Syringe 20G X 1\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309634",
      "ndc_label_name": "BD Luer-Lok Syringe 20G X 1\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309645",
      "ndc_label_name": "BD Luer-Lok Syringe 20G X 1-1/2\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309635",
      "ndc_label_name": "BD Luer-Lok Syringe 20G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309638",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309642",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309698",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309632",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309643",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1-1/2\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309639",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1-1/2\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309633",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309699",
      "ndc_label_name": "BD Luer-Lok Syringe 21G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309640",
      "ndc_label_name": "BD Luer-Lok Syringe 22G X 1\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309630",
      "ndc_label_name": "BD Luer-Lok Syringe 22G X 1\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309641",
      "ndc_label_name": "BD Luer-Lok Syringe 22G X 1-1/2\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309631",
      "ndc_label_name": "BD Luer-Lok Syringe 22G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309669",
      "ndc_label_name": "BD Luer-Lok Syringe 23G X 1\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309671",
      "ndc_label_name": "BD Luer-Lok Syringe 23G X 1-1/4\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309670",
      "ndc_label_name": "BD Luer-Lok Syringe 23G X 1-1/4\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366592",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366594",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366593",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290512146",
      "ndc_label_name": "BD Multifit Reusable Syringe 3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290511349",
      "ndc_label_name": "BD Osgood Biopsy Needle 16G X 1-5/16\"",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290320749",
      "ndc_label_name": "BD Pen Needle Micro U/F 32G X 6 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290320119",
      "ndc_label_name": "BD Pen Needle Mini U/F 31G X 5 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290320550",
      "ndc_label_name": "BD Pen Needle Nano 2nd Gen 32G X 4 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290320122",
      "ndc_label_name": "BD Pen Needle Nano U/F 32G X 4 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328203",
      "ndc_label_name": "BD Pen Needle Original U/F 29G X 12.7MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290320109",
      "ndc_label_name": "BD Pen Needle Short U/F 31G X 8 MM",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290005500",
      "ndc_label_name": "BD Plastipak Syringes Allergy 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290511346",
      "ndc_label_name": "BD Rosenthal Biopsy Needle 16G X 1-5/16\"",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290305951",
      "ndc_label_name": "BD SafetyGlide Allergy Syringe 26G X 3/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305908",
      "ndc_label_name": "BD SafetyGlide Shielded Needle 22G X 1-1/2\" 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290305907",
      "ndc_label_name": "BD SafetyGlide Shielded Needle 22G X 1-1/2\" 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305927",
      "ndc_label_name": "BD SafetyGlide Syringe/Needle 27G X 5/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290326895",
      "ndc_label_name": "BD Swab Single Use Regular Pad",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290006893",
      "ndc_label_name": "BD Swabs Single Use Butterfly PAD",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309694",
      "ndc_label_name": "BD Syringe 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309484",
      "ndc_label_name": "BD Syringe 30 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301627",
      "ndc_label_name": "BD Syringe 50-60 ML 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309653",
      "ndc_label_name": "BD Syringe 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290303348",
      "ndc_label_name": "BD Syringe Blunt Cannula 17G 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290303347",
      "ndc_label_name": "BD Syringe Blunt Cannula 17G 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290309664",
      "ndc_label_name": "BD Syringe Cath Tip 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301037",
      "ndc_label_name": "BD Syringe Cath Tip 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290303393",
      "ndc_label_name": "BD Syringe Dual Cannula 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301625",
      "ndc_label_name": "BD Syringe Luer Slip Tip 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301603",
      "ndc_label_name": "BD Syringe Luer Slip Tip 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309628",
      "ndc_label_name": "BD Syringe Luer-Lok 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301029",
      "ndc_label_name": "BD Syringe Luer-Lok 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290302830",
      "ndc_label_name": "BD Syringe Luer-Lok 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301031",
      "ndc_label_name": "BD Syringe Luer-Lok 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309661",
      "ndc_label_name": "BD Syringe Luer-Lok 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301033",
      "ndc_label_name": "BD Syringe Luer-Lok 30 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290302832",
      "ndc_label_name": "BD Syringe Luer-Lok 30 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290301027",
      "ndc_label_name": "BD Syringe Luer-Lok 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309703",
      "ndc_label_name": "BD Syringe Luer-Lok 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290309646",
      "ndc_label_name": "BD Syringe Luer-Lok 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301035",
      "ndc_label_name": "BD Syringe Luer-Lok 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309701",
      "ndc_label_name": "BD Syringe Slip Tip 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301025",
      "ndc_label_name": "BD Syringe Slip Tip 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290303134",
      "ndc_label_name": "BD Syringe Slip Tip 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301030",
      "ndc_label_name": "BD Syringe Slip Tip 10 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301032",
      "ndc_label_name": "BD Syringe Slip Tip 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290302831",
      "ndc_label_name": "BD Syringe Slip Tip 20 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290301034",
      "ndc_label_name": "BD Syringe Slip Tip 30 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309647",
      "ndc_label_name": "BD Syringe Slip Tip 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301028",
      "ndc_label_name": "BD Syringe Slip Tip 5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290301036",
      "ndc_label_name": "BD Syringe Slip Tip 60 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309624",
      "ndc_label_name": "BD TB Syringe 21G X 1\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309621",
      "ndc_label_name": "BD TB Syringe 22G X 1\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309626",
      "ndc_label_name": "BD TB Syringe 25G X 5/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305946",
      "ndc_label_name": "BD TB Syringe 26G X 3/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309625",
      "ndc_label_name": "BD TB Syringe 26G X 3/8\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290005620",
      "ndc_label_name": "BD TB Syringe 27G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305620",
      "ndc_label_name": "BD TB Syringe 27G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290309659",
      "ndc_label_name": "BD Tuberculin Syringe 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54868580700",
      "ndc_label_name": "BD Ultra-Fine Lancets",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324910",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 0.3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324909",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 0.3 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324911",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 0.5 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324912",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290512027",
      "ndc_label_name": "BD Yale Reusable TB Syringe 1 ML",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055523",
      "ndc_label_name": "BEC/Zinc TABLET ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00173038879",
      "ndc_label_name": "Beconase AQ SUSPENSION 42 MCG/SPRAY NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536335708",
      "ndc_label_name": "Bee Zee Tablet Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68180087913",
      "ndc_label_name": "Bekyree Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59385002260",
      "ndc_label_name": "Belbuca FILM 150 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002360",
      "ndc_label_name": "Belbuca FILM 300 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002460",
      "ndc_label_name": "Belbuca FILM 450 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002560",
      "ndc_label_name": "Belbuca FILM 600 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002160",
      "ndc_label_name": "Belbuca FILM 75 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002660",
      "ndc_label_name": "Belbuca FILM 750 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002760",
      "ndc_label_name": "Belbuca FILM 900 MCG Buccal",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68152010809",
      "ndc_label_name": "Beleodaq SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42367052125",
      "ndc_label_name": "Belrapzo Solution 100 MG/4ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006003330",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006003310",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006032510",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006032530",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006033510",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006033530",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006000510",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006000530",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011015",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075250",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378044301",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079014520",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033610",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011011",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079014501",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033650",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075210",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185082001",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075350",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185082005",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011115",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458086316",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075310",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378044401",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011111",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033710",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033750",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075410",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075450",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011215",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378044701",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033850",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011211",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011801",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033810",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075110",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378044101",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033510",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010915",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075150",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010911",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019401",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185032501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832048311",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505026201",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185021101",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832048411",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022901",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505026301",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378474501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378477501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832048511",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505026401",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185027701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022801",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019601",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505026101",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42367052025",
      "ndc_label_name": "Bendamustine HCl Solution 100 MG/4ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459034804",
      "ndc_label_name": "Bendeka SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063503",
      "ndc_label_name": "BeneFIX KIT 1000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063603",
      "ndc_label_name": "BeneFIX KIT 2000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063303",
      "ndc_label_name": "BeneFIX KIT 250 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063703",
      "ndc_label_name": "BeneFIX KIT 3000 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063403",
      "ndc_label_name": "BeneFIX KIT 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010590",
      "ndc_label_name": "Benicar HCT Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010530",
      "ndc_label_name": "Benicar HCT TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010630",
      "ndc_label_name": "Benicar HCT TABLET 40-12.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010690",
      "ndc_label_name": "Benicar HCT Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010730",
      "ndc_label_name": "Benicar HCT TABLET 40-25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010790",
      "ndc_label_name": "Benicar HCT Tablet 40-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010330",
      "ndc_label_name": "Benicar TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010390",
      "ndc_label_name": "Benicar Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010303",
      "ndc_label_name": "Benicar TABLET 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010490",
      "ndc_label_name": "Benicar Tablet 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010430",
      "ndc_label_name": "Benicar TABLET 40 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65597010130",
      "ndc_label_name": "Benicar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "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": "Tier 4",
      "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": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008802",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008842",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008847",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401010101",
      "ndc_label_name": "Benlysta SOLUTION RECONSTITUTED 120 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401010201",
      "ndc_label_name": "Benlysta SOLUTION RECONSTITUTED 400 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63801010701",
      "ndc_label_name": "Bensal HP OINTMENT 3-6 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187519025",
      "ndc_label_name": "BenzaClin GEL 1-5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187519035",
      "ndc_label_name": "BenzaClin with Pump GEL 1-5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187519050",
      "ndc_label_name": "BenzaClin with Pump GEL 1-5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187520546",
      "ndc_label_name": "Benzamycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001050",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034601",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042631",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042671",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071207",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877010501",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014330",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904665760",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162053610",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057301",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904656461",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162053650",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69387011905",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904656460",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739002910",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071206",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057305",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024701",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69387011901",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904590460",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071405",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001060",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664013388",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024705",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014320",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071306",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162053710",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224000150",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042731",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042771",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057505",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664013488",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071307",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877010601",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69387012001",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014420",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071505",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162053750",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057501",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014430",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224000160",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739012410",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877010605",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69387012005",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67405083512",
      "ndc_label_name": "Benzoyl Peroxide Cleanser Liquid 6 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67405083506",
      "ndc_label_name": "Benzoyl Peroxide Cleanser Liquid 6 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51224040010",
      "ndc_label_name": "Benzoyl Peroxide FOAM 5.3 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51224040110",
      "ndc_label_name": "Benzoyl Peroxide Foam 9.8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802030896",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802030801",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802021601",
      "ndc_label_name": "Benzoyl Peroxide GEL 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802021696",
      "ndc_label_name": "Benzoyl Peroxide GEL 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67405083005",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67405083008",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802031834",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802031801",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67405082508",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67405082505",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802028001",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802028034",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64980032801",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682090146",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682090023",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781705449",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781709459",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980032802",
      "ndc_label_name": "Benzoyl Peroxide-Erythromycin GEL 5-3 % EXTERNAL",
      "drug_tier": "Tier 2",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038111",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243332",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010310",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243721",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035611",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243732",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010301",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243321",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010401",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243832",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010410",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243421",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243821",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679061",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010510",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243921",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243521",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010501",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243532",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678961",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243932",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208062902",
      "ndc_label_name": "Bepreve SOLUTION 1.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208062901",
      "ndc_label_name": "Bepreve SOLUTION 1.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833082502",
      "ndc_label_name": "Berinert KIT 500 UNIT Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43538097160",
      "ndc_label_name": "Beser Kit 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43538097060",
      "ndc_label_name": "Beser Lotion 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208044605",
      "ndc_label_name": "Besivance SUSPENSION 0.6 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00008010001",
      "ndc_label_name": "Besponsa SOLUTION RECONSTITUTED 0.9 MG Intravenous",
      "drug_tier": "Tier 4",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917003955",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54868102501",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904431560",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986001759",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003956",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001782",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48107004906",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536490201",
      "ndc_label_name": "Beta Carotene Capsule 25000 UNIT Oral",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845078001",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055524",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629010302",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001220",
      "ndc_label_name": "Beta Carotene CAPSULE 25000 UNIT ORAL",
      "drug_tier": "Tier 3",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00168026550",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131003",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "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": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029052",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802037635",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029017",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131001",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802037632",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130901",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130903",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565002359",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672134004",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565002329",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026760",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026730",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672134003",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089749",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038215",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026850",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089715",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038245",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026815",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565001915",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565001951",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005546",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713065915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005515",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038045",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713075937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672127406",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038015",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713065937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672127401",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005760",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713072853",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61748047560",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802002146",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713080753",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005615",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038115",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038145",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005646",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472037045",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168004046",
      "ndc_label_name":